1
nmH^wi
mill!
1 HI 1
km
Omv.OF
ijmM
INDEX
TO
THE MODERN HOSPITAL
VOLUME XI
JULY TO DECEMBER, INCLUSIVE
1918
MM
WW
WW
.^>^v
PUBLISHED BY
THE MODERN HOSPITAL PUBLISHING CO., Inc.
CHICAGO, ILL.
KK
^(oO
m
\i.\\
cop.l
THE
MODERN HOSPITAL
EDITORS
HENRY M. HURD
FREDERIC A. WASHBURN
WINFORD H. SMITH
S. S. GOLDWATER
W. L. BABCOCK
JOHN A. HORNSBY
M. K. CHAPIN,
Managing Editor.
,
INDEX
This index contains in a single alphabetical sequence the names of authors and subjects of all articles published
in The Modern Hospital during the six months covered by this volume. The follovifing abbreviations indicate special
departments in which articles appeared: Ab., abstract in Current Hospital Literature; Bk. Rev., Book Reviews;
Corr., Letters to the Editor; Ed., Editorials; Q. and A., Queries and Answers.
Accounting Committee of American Hospital Association, Report
o£ 330
Accounting, Hospital— Porter and Carter 102, 173, 266, 371, 448
Adler, Eleanor — An Experimental Employment Bureau for Crip-
ples 402
Administrative Articles —
Economy Campaign, Cooperative, in all Departments of the Hos-
pital—Bacon 430
Economy Problem, War-Time, in the Hospital— Devan 445
Efficiency System for Medical Work of State Hospitals — Singer.. 260
Food Waste in Hospitals — Pitcher 491
Fuel, Saving of, in Hospitals — U. S. Fuel Administration 250
Heating and Power Plant Economies for Hospitals — Kimball 437
Hospital Administration, Discussion by Massachusetts Medical
Society 131
Hospital Management, Some Problems of — Tuley 169
Hospitalism— Its Causes and Treatment— Clark 53
Housekeeping, Hospital, Its Worries and Cares — Jamieson 15
Laundry System which Has Proved Successful — Fish 433
Medical Stafif, Resident, Self-Government for— Bacon 17
Visitors and Visiting in Hospitals— Geffen 61
Admitting Desk, Friendly Relations with Patients Established at
(Corr.)— Gage 203
Adolescent Clinic of Stanford University Medical School, Work of.
(Ab.)— Gates 151
Advertising the Public Sanatorium — Gammons 409
Aeroplane, Radio-Chirurgical— Nemirovsky and Tilmant (Ab.) 499
After Care of Disabled Men, Inter-Allied Conference on 210
Agatha Hospital, Clinton, Iowa 29
Agostini, C — The Economic Probleni of the Italian Hospitals for the
Insane (Ab.) , 152
Alder Hey Military Orthopedic Hospital 375
Ambulance, Trolley Hospital, First 98
American Association of Hospital Social Workers Organized 205
American Association of Industrial Physicians and Surgeons, Third
Annual Meeting of 133
American Dietetic Association, Atlantic City Meeting of 306, 406
American Home Economics Association, Meeting of 143
American Hospital, Chicago 284
American Hospital Association. Bulletin of 35, 126, 227, 472
Institutional Membership in. Advantages of (Ed.) •,..460
Twentieth Annual Convention, Announcement of ., . .227
Twentieth Annual Convention Commercial E.xhibit at (Ed.) 388
Twentieth Annual Convention, Editorials on 188, 286
Twentieth Annual Convention, Report of 310
American Medical Association. Sixty-ninth Annual Session of 130
American Medico-Psychological Association, Seventy-fourth Annual
Meeting of 45
American Nurses* Club in London 417
American Public Health Association Meeting, Announcement of,... 309
Influenza Causes Postponement of 401
Anjerican Women's Hospitals — Conger 68, 346
American Women's Hospitals in France, Work of 418
Ancker, Arthur B. — The War and the Civil Hospitals (President's
Address) 327
Anesthetic Screen 348
Architectural Articles —
Ashland General Hospital, Ashland, Wis.— Dodd 264
Barlow Sanatorium, New Four-Patient Cottage at — Klotz 378
Brookville General Hospital, Brookville, Pa.— Bailey 165
Buffalo General Hospital. Memorial Hall of— Stevens 20
Construction, Hospital, Details of — Perry 469
Hackensack Hospital, Nurses' Home of — Washburn 84
Tuberculosis Sanatorium Buildings. Small, Planning of — Burt.... 1
Vancouver General Hospital. Military Annex of — MacEachern. . . .257
Argentina, Anti-Tuberculosis Work in— Coni ( Ab.) 499
Army General Hospital, U. S., 2,500-Bed, to be Built in 100 Days,. 309
Army Litter, Field and Hospital Use for 70
Army Nursing, Program of — Goodrich 410
Army Nursing Question (Ed.) 189
Army School of Nursing 50
Army School of Nursinp; and the Civil Hospital 290
Army School of Nursing. Camp Wadsworth, S. C 413
Ashhind General Hospital, Ashland. Wis.— Dodd 264
Atlantic City Meeting of American Hospital Association
188, 227, 2S6, 310, 388
Attendant, Trained— Dakin 198
Audit Committee, American Hospital Association, Report of 329
Australian Institutions, Purchasing Methods Adopted by (Corr.) —
MacLennan 346
B
Bacon, Asa S. — Cooperative Economy Campaign in All Departments
of the Hospital 430
Bacon, Charles B. — Self-Government for the Resident Medical Staff. 17
Bahama General Hospital and Asylum— Milne 37C
Bailey, Emmet E.— How to Build an Efficient General Hospital for
a Small Community 165
Baldv, J. M.— Has Every Hospital an Inherent Right to an Intern?. 89
Barlow Sanatorium, New Four-Patient Cottage at— Klotz 378
Bass, Elizabeth and Loeber, Maud— Physical Status of Juvenile De-
linquents in the Reformatories of the City of New Orleans.
(Ab.) 151
Beckman. James W.— Floating Hospital of St. John's Guild Again
at Work 92
Bedford Hills Psychopathic Hospital of the Laboratory of Social
Hygiene (Ab.)— Southard and Davis 499
Belgium. A Message from (EJ.) 286
Belgium, America's Help of. After the War— Sand 256
Belgium, Our Opportunity in (Ed.l 460
Bellevue, France, American Hospital for the Study of Gas Cases at. 429
Benedict, Sarah — Food Conservation in Ohio Hospital 206
Blaine Foreign Body Localizing Instrument 347
Blind, St. Dunstan's Hostel for— McCallin 29B
Blind. Who are They? (Ed.) 290
Blood Counting Apparatus 421
Bloomington Girls' Industrial Home 375
Blue. Rupert— Influenza, Epidemic, and the United States Public
Health Service 423
Blue Cross Hospital for Horses — Forward and Lees 349
Blue Triangle Hut— Nissley 416
Bologna, Institute of Reeducation for Crippled Soldiers (Ab.) 476
Bookkeeping, Hospital : See Accounting, Hospital.
Books Received for Review 224, 346, 498
Book Reviews 498
Boschi, G. — The Hospital for Nervous Diseases Villa del Seminario
at Ferrara ( Ab.) 223
Bowditch, V. Y.— .\ Children's Pavilion at the Sharon Sanatorium
( Ab.) 222
Bowen, A. L. — Standardization of State Hospitals 81
Bowman, John G. — The Business of Medicine and the Profession of
Medicine 123
Bradshaw, Emerson O. — Influenza Relief Work of Stock Yards Com-
munity Clearing House (Corr.) 497
Brazil, Eugenics in 457
British Columbia. Hospitals of, First Convention of 136
Brooks, W. A.— Out-Door Treatment of Spanish Influenza 427
Brookville General Hospital— Bailey 165
Buenos Aires, Hospitalization of Pulmonary Tuberculosis in (Ab.) —
Coni 222
Buffalo General Hospital, Memorial Hall of— Stevens 20
Bulletin of the American Hospital Association 35, 126, 227, 472
Bunk, Glennan Adjustable — Kerns 194
Bunn, F. S., Death of (Ed.) 465
Burnette, Norman L.— Occupational Therapy in Canadian War
Hospitals 401
Burt, James D.— The Planning of Small Tuberculosis Sanatorium
Buildings 1
Butterfield, C. L.— Hospital Housekeeping and War-Time Economies. 220
Byrne, Miriam — Methods of Indexing Hospital Clinical Records 86
Cabot Course of Case Records — Painter 355
Cabret, D. — The New Tuberculosis Sanatorium "Santa Maria" (Ab.).223
Camp Sevier, Food Conservation in 51
Canadian Civil Hospitals' Part in War Work — MacEachern 257
Canadian National Association of Trained Nurees and Canadian
Association of Nursing Education, Meeting of 46
Canadian Rehabilitation and Reconstruction Work — Kidner 393
Canadian Red Cross, Work Accomplished by, in 1917 49
Canadian War Hospital, Occupational Therapy in — Burnette 401
Carry On 211
Carter, Herbert K. and Porter, Charles A. — Hospital Accounting
102, 173, 266, 371, 448
Case Records of Massachusetts General Hospital— Painter 355
Cassette, Mcintosh X-Ray " Verithin" 80
Catholic Hospital Association, Report of Third Annual Meeting of. 120
Address of President — Moulinier 122
Chapin, M. K. — Hospitals and Hospital System of Chile 440
Chart Rack, Sacred Heart Hospital, Fort Madison, Iowa 29, 112
Children's Hospitals —
Children's Hospital, Columbus, Ohio 187
Children's Hospital, Philadelphia 385
Children's Hospital, Washington, D. C 384
Floating Hospital of Saint John's Guild — Beckman 92
Hospital of Extended Grace to Women and Children, Pyeng Yang,
Korea — Hall 252
Children's Pavilion at Sharon Sanatorium (Ab.) Bowditch 222
Chile, Hospitals and Hospital System of — Chapin 440
Chile, Hospitals of (Ed.) 463
China, North, Pitiable Condition of Insane in (Ab.) — Ingram 152
Chinese Women's Hospital, Work in (Corr.) — Murdoch 345
Cincinnati Public Health Council— Dinwiddle 180
Civil Hospital, Future of (Ed.) 191
Civil War Hospitals 270
Clark, Pliny O. — Hospitalism — Its Causes and Treatment 53
Cleveland Hospital Council, Purchasing Bureau of 107
Clinics, Evening Pay — Warner 143
Clinics. Venereal Disease— Davis 436, 481
Coal, Spontaneous Combustion of (Ed.) 192
Community Hospitals —
Ashland General Hospital— Dodd 264
Brookville General Hospital — Barley 165
Kerrville Sanitarium Hospital — Harrison 5S
Community Hospitals, Efficient, General, Problem of Building of —
Bailey 165
Community Hospitals, Small. Plan for First Unit of (Ed.) 190
Community Nurses : See Public Health Nurses.
Conger, Charlotte M. — Work of the American Women's Hospitals in
France 68, 346
Coni, E. R. — Anti-Tuberculosis Organization in Argentina (Ab.)...,499
The Hospitalization of Patients with Pulmonary Tuberculosis in
Buenos Aires (Ab.) 222
Conlev. Emma— The Red Cross Dietitian Service 407
Connecticut Training School for Nurses— Landis 487
Connecticut Training School of New Haven Hospital, Vacation
Cottages for— Cox 344
Conservation: See Drugs, Conservation of; Economy: Food Con-
servation : Fuel Conservation : Gauze, Conservation of.
Construction, Hospital, Details of — Perry 469
Convalescents, Care of, in the Ospedale Maggiore of Milan (Ab.) —
Ronzani 152
Corn, Sweet, Preparation of, and Drying 143
Cottage Hospital, Creston, Iowa 112
Cott.ir:. Soiled. Laundering of, for French Military Hospitals (Ab.).224
County Hospital, Jefferson, Fairfield, Iowa 187
County Jails of Illinois — Hinrichsen 358
IV
INDEX
Cox Simon F. — ^Vacation Shore Cottage for Nurses 344
Crawford, Charlotte H.— Life-Saving Surgical Dressing Squads in
France • ^.' '
Creston, Iowa, Scheme for Rural Hospitalization in (Corr.) — Kep-
ford 200
Crippled: See also Disabled.
Crippled Men, American School of Rehabilitation for— McMur-
trie "*>, 145
Crippled Soldiers. Institute of Reeducation for, in Bologna (Ab.)..476
Cripples, Experimental Employment Bureau for— Adler 40^
Cubic Feet per Patient in Isolation Hospital IQ. & A.) ...420
Current Hospital Literature lol. —-■ *^^
D
Floating Hospital of Saint John's Guild Again at Work— Beckman . 92
Food Conservation in Military Hospitals 51
Food Conservation in an Ohio Hospital — Benedict 206
Food Conservation in Hospitals (Ed.) 289
Food Waste in Hospitals— Pitcher 491
Foreign Body Localizing Instrument 347
Forward. Charles W. and Lees, George Frederick— At The Sign of
the Blue Cross 349
France, Organization of Tuberculosis Work for Soldiers in (Ab.)..498
Fraternal Institution for the Free Treatment of Tuberculosis —
Rutledge • 155
Freyberg Light-? roof Dark-Room Ventilator 600
Fruits and Vegetables. Dehydrated 142
Fuel and Power Plant Economies for Hospitals— Kimball 437
Fuel. Conservation of. in Hospitals— U. S. Fuel Administration 250
Dakin. Florence— The Trained Attendant 198
Dark-Room Ventilator, Light-Proot ■ • ■ • »™
Davis, Michael M.. Jr.— Venereal Disease Clinics .436, 481
Davis, Michael M. and Warner, Andrew R.— Dispensaries, Their
Management and Development (Bk. Rev.) 498
Who Should Be Dispensary Patients? 6^
Davis Suprapubic Drainage Bottle -^^o
Dayton State Hospital, Mental, Dayton, Ohio 186
De Khotinsky Water-Bath ■.■•■• ^^^
De Monclos, Katherine — How the American Red Cross in trance
Mends Mutilated Faces :•■ X'- :•■'"''
De Paoli, G.— Male Divisions Intrusted to Female Nurses in SUte
Hospitals for the Insane (Ab.) 223
Dehydrated Vegetables and Fi-uits -^-j^^-
Delano, Jane A.— The Nursing Program of the American "ed
Delinquents! juvenile, PhyVicai Status of. Based on Examinations of
Children in Reformatories of New Orleans— Bass and Loeber..l51
Dench Anesthetic Screen yw,-; ?|S
Dennison Manufacturing Company. Health Work of — Weber 4SS
Devan. Thomas Alan— War-Time Economy Problem in the Hos-
pital "=;
Diabetics. Gluten Flour for 308
Diet and Nutrition, Latest Books on 208
Dietary Department of Hospital, Management of — Graves 394
Dietetic Association. American. Meeting of 306.406
Dietetics. Department of 61. 142. 206. 306, 406. 491
Dietetics. Nurses' Course in 308
Dietitian in Social Welfare Service (Ed.) 189
Dietitian Problem in the Small Hospital (Q. & A.) 79
Dietitian Service. Red Cross— Conley 407
Dietitians. College Course for . ■ • ■ ■ ■ -fS?
Dietitians. News Notes of 209, 409, 496
Dietitians' Question Box 308
Disabled : See also Crippled.
Disabled, Agriculture for 74
Disabled Men. Hostels for. in London 50
Disabled Soldiers and Sailors. Human Factors in the Reconstruction
of— McMurtrie 476
Disabled Soldiers. Sailoi-s and Marines. Aid for in Pennsylvania 297
Dispensaries, Disreputable, Massachusetts Finds Remedy for 73
Dispensaries. Their Management and Development — Davis and War-
ner (Bk. Rev.) 498
Dispensary and Out-Patient Work 73, 143, 481
Dispensary Patients. Admission of- Davis and Warner 64
Distilled Water: See Water Still 274
Dodd. J. M.— The Ashland ( Wis.l Community Hospital 264
Douglass, Stephen A. — The State Sanatorium and the Labor Prob-
lem
Drainage. Suprapublic, Vacuum Bottle for 226
Dressing Station. British, Advanced, On Newly Captured Ground... 88
Drew, Charles A.— The Standardization of Hospitals 66
Drug and Other Supplies, Conservation of — MacEachern 66
Dried Vegetables and Fruits 142
E
East Haven Hospital. Richmond. Indiana 38.i
Economies. War-Time. and Hospital Housekeeping — Butterfield 220
Economy : See also Conservation.
Economy Campaign. Cooperative, in All Departments of the Hospi-
tal—Bacon 430
Economy Problem, War-Time, in the Hospital — Devan 446
Editorials 30. 114, 188. 286. 386. 460
Educational Work for Children at Lakeside Hospital — Warner 354
Edward L. Trudeau Institution in France — White 247
Efficiency System for Medical Work of State Hospitals— Singer 260
Electric Warming Pad. Safety 153
Electrothermal Applicators 422
Elei Blood-Counting Apparatus 421
Elks. Reconstruction Hospital Presented to Government by 148
Elm City Hospital. New Haven. Connecticut 284
Emery University. Atlanta. Georgia. Syphilis Clinic of (Ab.) —
Emery 152
Emery. W. B.— The Syphilis Clinic of Emery University. Atlanta.
Ga. ( Ab.) 152
Employment Bureau for Cripples— Adler 402
Epileptics. Institutions for the Care of — Shanahan 364
Episcopal Hospitals. Meeting of. Report of 344
Eugenics in Brazil 457
Evangelical Deaconess" Hospital. Marshalltown. Iowa 29
Facial Mutilations: See Mutilations. Facial.
Farm, Garden and Dairy. Institutional Consultant for (Corr.) —
Hoblit 202
Farmer. W. S.— Mrs. Peggy Ann Sutton and Her Quilt (Corr.) 200
Feeble-Minded Inmates of New York Institutions, to be Sifted Out. 5
Field Editors' Note Books 27, 112, 186, 284, 384, 458
Findley, June — Dietary Studies Made in the Missouri State Hospitals
for the Insane 306
Fish, Lina Stryker— Laundry System Which Has Proved Successful . 433
Gage, Harriet — Friendly Relations with Patients Established at
Admitting Desk (Corr.) 203
Gammons, Herbert F. — Advertising the Public Sanatorium 409
Gas Cases, American Hospital for the Study of, Bellevue. France 429
Gates. Amelia E. — The Work of the Adolescent Clinic of Stanford
University Medical School (Ab.) 151
Gauze and Bandage Cutting Machine 225
Gauze. Conservation of — Shilt 66
Gauze Dressings, Knitted 347
Gauze Rolling and Folding Machine 421
Geffen, Joseph— Visitors and Visiting in Hospitals 61
Gelatine Food Products Recognized by U. S. Food Administration. .409
Gelatine, Food Value of 308
Genoa. Neurological Center of the Territorial Army at (Ab.) 499
George F. Geisinger Memorial Hospital. Danville. Pennsylvania —
Robinson 281
Girls. Successful Private Institution for. Bloomington. Ill 375
Glennan Adjustable Bunk— Kerns 194
Gluten Flour for Diabetics 308
Goff. J. R.— The Woman's Hospital in the State of New York (Ab.).222
Goldwater. S. S. — Hospital Disintegration or Hospital Conservation
—Which? (Ed.) 30
Patriotic Duty of Hospitals During the War ( Ed. I 115
Report of the War Service Committee. American Hospital Asso-
ciation Meeting, Atlantic City. New Jersey 332
Goodrich. Annie W.— The Nursing Program of the Army 410
Goodwill Electric Heating Pad 422
Grant Hospital, Chicago— Robinson 23
Grant Hospital, Columbus. Ohio 28
Grant Hospital. Columbus. Ohio — Robinson 183
Graves. Lulu G. — The Management of the Dietary Department of
the Hospital 394
Gray. Carolyn E. — Vassar's Response to the Nation's Need for
Nurses 204
Hackensack Hospital, Nurses* Home of — Washburn 84
Hackley Hospital, Muskegon, Mich 284
Hall, Rosetta Sherwood — The Hospital of Extended Grace to Women
and Children 252
Hamilton, Eleanor E. — A Plea for the Hourly Nursing Service as
a War Measure (Corr.) 78
Harpet Hospital. Detroit. Mich 29
Harrison. Mai-garet — The Community Hospital as Viewed by a
Nurse 68
Health and Modern Industry 299. 418. 488
Health Insurance and Hospitals— Howell 414
Health Insurance and Hospitals— Lapp 398
Health Insurance and Its Relation to Hospitals— Howell 466
Health Insurance, Its Medical and Hospital Aspects— Lapp 160
Heat and Light Infuser. Thermolite 153
Heat Applicators 422
Heating Plants : See Fuel.
Helen C. Juilliard, Floating Hospital 92
Heliotherapy and X-Rays in the Treatment of Surgical Tubercu-
losis 263
Heliotherapy. Treatment of External Tuberculosis by (Ab.) 476
Hersey, Thomas L. Lee — Influenza Relief Work of Pusey and Jones'
Ship-Building Company 490
Hibbs. Henry H.— The South's First School of Social Work and
Public Health Nursing 147
Hinrichsen, Annie— The County Jails of Illinois 358
Hoblit. Charles T.— The Institutional Farm. Garden, and Dairy Con-
sultant (Corr.) 202
Hominy, Hospitals Making Their Own 143
Horses, Blue Cross Hospital for — Forward and Lees 349
Hospital Accounting : See Accounting, Hospital.
Hospital Administration : See Administration, Hospital.
Hospital Association : See American Hospital Association ; British
Columbia Hospital Association ; Catholic Hospital Association ;
Minnesota Hospital Association ; New Jersey Hospital Associa-
tion.
Hospital Bed. Railway, Glennan Adjustable — Kerns 194
Hospital Construction : See Architectural Articles.
Hospital Disintegration or Hospital Conservation — Which? (Ed.) —
Goldwater 30
Hospital Executives. Red Cross, Needed for (Ed.) 34
Hospital. General. Organization of Ochsner 124
Hospital Life, Stories of. Wanted (Ed.) 192
Hospital. Medical and Special Meetings 43. 130
Hospital of Extended Grace to Women and Children, Pyeng Yang,
Korea— Hall 252
Hospital, Past. Present and Future— Monro 292
Hospital People, Vital Issues to be Decided by (Ed.) 117
Hospital Records : See Records. Hospital.
Hospital Ships: See Floating Hospitals: Ships. Hospital.
Hospital Social Workers: See Social Workers. Hospital.
Hospital Staff: See Staff, Hospital.
Hospital Tent: See Tent. Hospital.
Hospital Train : See Train. Hospital.
INDEX
Hospitals : See also Children's Hospitals ; Community Hospitals :
County Hospitals : Insane, Hospitals for : Mental and Nervous
Diseases, Sanatoriums for; Military Hospitals; Ked Cross Hos-
pitals ; Small Hospitals ; State Hospitals ; Tuberculosis Hospi-
tals.
Hospitals, Civil, and Allied Institutions, Mobilization of. for Na-
tional Service (Ed.) 31
Hospitals, Civil, and the War — Ancker 327
Hospitals. Conduct of— Corwin 113
Hospitals. Individual, Descriptions of —
Ashland General Hospital, Ashland, Wis.— Dodd 264
Bahama General Hospital and Asylum— Milne 376
Brookville General Hospital. Brookville, Pa.— Bailey 165
Buffalo General Hospital, Memorial Hall of— Stevens 20
Edward L. Trudeau Institution in France — White 247
Floatinjr Hospital of Saint John's Guild— Beckman 92
George F. Geisinger Memorial Hospital, Danville, Pa. — Robinson. .281
Grant Hospital. Chicago — Robinson 23
Grant Hospital. Columbus, Ohio — Robinson 183
Hospital of Extended Grace to Women and Children, Pyeng
Yang, Korea— Hall 252
Kerrville Sanitarium Hospital. Kerrville, Texas — Harrison 58
Saint Anthony's Hospital, Carroll, Iowa— Robinson 108
Hospitalism — Its Causes and Treatment— Clark 53
Hospitalism. Practical Remedy for — MacEachein 379
Hospitalization. Rural. A Scheme for. Creston. Iowa (Corr.) — Kep-
ford 200
Hot-Air Apparatus 154
Housekeeping. Hospital. Its Worries and Cares — Jamieson 15
Howell. Thomas— Health Insurance and Its Relation to Hospitals. .466
Workmen's Compensation, Health Insurance and Hospitals 414
Ilbarritz. Hospital in. for External Tuberculosis (Ab.) 497
Illinois. County Jails of— Hinrichsen 358
Illinois Course tor Community Nurses 49
Immigrant. Health Standards and Care for 130
Indianapolis City Hospital 385
Indianapolis Methodist Hospital 386
India. Red Cross Work in 168
Industrial Welfare. Department of : See Health and Modern Industry.
Industrial Welfare, Proposed Federal Control of 299
Industrial Home for Girls, Bloomington, III 375
Industrial Physicians and Surgeons. American Association of, Third
Annual Meeting of 133
Industrial Rehabilitation of Soldiers and Sailors : See Occupational
Therapy, Vocational Rehabilitation, and Industrial Reeducation.
Influenza Epidemic and Social Service lEd.) 390
Influenza. Epidemic, and United States Public Health Service— Blue. 423
Influenza Epidemic. Quick Action of Red Cross in 392
Influenza, Measures against 370
Influenza Relief Work of Pusey and Jones Ship-Building Company —
Hersey 490
Influenza Relief Work of Stock Yards Community Clearing House
ICorr. I— Bradshaw 497
Influenza Situation and Hospitals (Ed.) 386
Influenza, Spanish. Out-Door Treatment of— Brooks 427
Ingram. J. H.— The Pitiable Condition of the Insane in North
China (Ab.) 152
Inheritance Tax, Federal, and Hospitals (Ed.) 188
Insane: See also Nervous and Mental.
Insane, Handwork of, (Peggy Ann Sutton and Her Quilt) (Corr.) —
Fanner 200
Insane. Hospitals for —
Davton State Hospital. Mental. Dayton. Ohio 186
Kaiamazoo State Hospital. Mental 458
Sheppard and Enoch Pratt Hospital. Towson. Baltimore 458
Insane in North China. Pitiable Condition of (Ab.)— Ingram 152
Insane, Italian Hospitals for. Economic Problems of (Ab.) Agostini.152
Insane. Missouri State Hospitals for. Dietary Studies in — Findley. . .306
Insane, Standardization of Hospitals for — Sandy 6
Insane. State Hospitals for, Male Divisions of. Intrusted to Female
Nurses (Ab.)— Paoli 223
Insurance. Health : See Health Insurance.
Interns. Duties of (Q. & A.) 221
Interns in Special Hospitals, and War Service 42
Interns. Rights of Hospital to— Baldy 89
Iroquois Memorial Hospital. Chicago 29
Isolation Hospital. Cubic Feet per Patient in (Q. & A.) 420
Italian Hospitals for the Insane, Economic Problem of (Ab.)—
Agostini 152
Jails. County, of Illinois— Hinrichsen 358
Jamieson, Mary A. — Hospital Housekeeping, Its Worries and Cares.. 15
Java, Hospital in. for Royal Navigation Company 302
Jefferson County Hospital. Fairfield, Iowa 187
K
Kahn. Max— The Department of Laboratories 271
Kalamazoo State Hospital, Mental 458
Kepford, Aretas E.— A Great Vision and Its Realization (Corr.) 200
Kerrville Sanitarium Hospital, Kerrville, Texas— Harrison 58
Kidner. T. B.— Canada's Rehabilitation and Reconstruction Work.. 393
Kimball. D. D.— Heating and Power Plant Economies for Hospitals. 437
Klotz, Walter C— New Four-Patient Cottage at Barlow Sanatorium. 378
Korndoerfer. .Aug. — The Nursing Problem : Third-Year Training
Under Government Supervision (Corr.) 202
Korean Hospital Work (Hospital of Extended Grace to Women and
Children. Pyeng YangI— Hall 252
Labor Recruiting Agencies. Government, Medical Examination Card
for
.301
Laboratories. Department of — Kahn
Laboratories. Relation of, to Hospitals— MacCarty 381
Laboratory Technicians, More. Needed (Ed.) 32
Ladd, Mrs. Maynard, Work of, in Repairing Facial Defects — De
Monclos 158
Lakeside Hospital, Cleveland —
Educational Work for Children in— Warner 354
War Time Economies in— Shilt 66
Landis, Maude — Connecticut Training School for Nurses 487
Lapp, John A.— Health Insurance and the Hospitals 398
Insurance : Its Medical and Hospital Aspects 160
Latchstring Out 118, 192, 390
Latin America, Our Relations with (Ed.) 463
Laundry System Which Has Proved Successful— Fish 433
Lay of the Government Lady 209
Lebredo. M. G. — Necessity of Hospitalizing Typhoid Patients (Ab.).224
Lees. George Frederick, and Forward. Charles W.— At the Sign of
the Blue Cross 349
Legislative Committee of American Hospital Association, Report of. 331
Letters to the Editor 78, 345. 497
Liberty Loan, Fourth (Ed.) 286
Limbless Men, Hospital for, at Cardiff (Ab.) 223
Linoleum, Battleship, How to Lay (Q. & A.) 150
Litter, Army. Field and Hospital Use for.... 70
Little Journeys to Places and People Worth Knowing — Robin-
son 23, 108, 183, 281, 454
Liverpool, England, Pneumonia Ward of American Red Cross Hos-
pital at 429
Loder, Cornelius S. — Report of Audit Committee, American Hos-
pital Association Meeting, Atlantic City, New Jersey 329
Loeber, Maud and Bass, Elizabeth — Physical Status of Juvenile
Delinquents in the Reformatories of the City of New Orleans.. 161
Logan Sputum Cup 163
Louisville City Hospital, Organization of — Tuley 169
Louisville City Hospital, Social Service Training of Nurses at 206
Luther, Jessie — Occupational Treatment in Nervous Disorders 11
M
McCallin, Mrs. Sidney— Blindness a Temporary Disablement 295
MacCarty, William Carpenter^Relation of Laboratories to Hos-
pitals 331
MacEachern, Malcolm T. — A Canadian Civil Hospital's Part in
War Work 257
Conservation of Drugs and Other Supplies 66
Practical Remedy for Hospitalization 379
Mcintosh X-Ray Cassette 80
MacLennon, W. H. — Associated Purchase Method Adopted by Aus-
tralian Institutions 346
McMurtrie, Douglas C. — An American School of Reeducation for
Crippled Men 76. 146
Human Factors in the Reconstruction of Disabled Soldiers and
Sailors 476
Maimin Gauze and Bandage Cutter 225
Management. Hospital : See Administration. Hospital.
Martin, Franklin — The Volunteer Medical Service Corps 275
Massachusetts Finds Effective Remedy for Disreputable Dispensaries. "73
Massachusetts Medical Society, One Hundred and Thirty-Seventh An-
nual Meeting of 131
Massachusetts Sick. Organized Care for (Ab.) — Whitehill 224
Maternity Hospital in Arezzo (Ab.) — Pagliani 223
Mayo Clinic. Rochester. Minn. (Ab.) — Tange 222
Mc. names beginning with ; see under Mac.
Medea. E.— The Course of Instruction for the Wounded of the
Biffi Pavilion (Ab.) 222
Medical Department of the Army. Some Aspects of Program of. and
Their Effect on Civil Hospitals— Smith 334
Medical Industry Section of War Industries Board — Simpson 278
Medical Staff: See Staff, Hospital.
Medicine, Business of and Profession of — Bowman 123
Medicine, Organized Practice of (Ed.) TB
Memoirs of a Head Nurse 60, 137, 196, 293, 391, 468
Mental Hospitals, Occupational Therapy in 45
Mental Hygiene in the War 196
Mercy Hospital, Philadelphia 385
Mercy, U. S. Hospital Ship 213
Methodist Hospital, Indianapolis 385
Miami Valley Hospital, Food Conservation in 206
Michigan State Nurses' Association. Annual Meeting of 48
Milan. Ospedale Maggiore of. Care of Convalescents in (Ab.) —
Ronzana 152
Military Annex of Vancouver General Hospital — MacEachern 257
Military Hospitals. Food Conservation in 51
Military Hospitals, Vocational Instnictors Needed in 405
Milne. Mrs. T.— The Bahama General Hospital and Asylum 376
Minnesota Hospital Association. First Annual Convention of.... 49, 134
Missouri State Hospitals for the Insane. Dietary Studies in—
Findley 306
Modern Hospital, Consolidation of Editorial and Business Offices
of (Ed.) 118
Modern Hospital — Prospect and Retrospect (Ed.) 191
Modern Woodmen of America Sanatorium. Woodmen, Co. — Rut-
ledge 156
Monro. A. S.— The Hospital — Past. Present and Future 292
Moulinier. Charles B.— President's Address. Catholic Hospital Ac-
sociation 122
Mount Carmel Hospital. Columbus. Ohio 186
Mount Sinai Hospital, New York. Nurses' Home of — Robinson 464
Moving Pictures Displayed on Camp Hospital Ceilings 177
Murdoch. Beatrice W. — Work in Chinese Women's Hospitals 346
Mutilations. Facial. Repair of — De Monclos 158
Mutilations, Facial, Work of English Sculptors in Repairing 148
La Panne, Belgium, War Hospital. Site of 113
National Tuberculosis Association. Fourteenth Annual Meeting of.. 46
Nemirovsky, M. A. and Tilmant, M. — Radio-Chirurgical Aeroplane
(Ab.) 499
INDEX
Nervous Diseases, Hospital for, Villa del Seminario at Ferrara
(Ab.)— Boschi 223
Ner\'ous Disorders, Occupational Treatment in — Luther 11
Neurological Center of the Territorial Arniy at Genoa (Ab.) 499
Newell Hot-Air Apparatus 15-*
Newfoundland Orphan's Home at St. Anthony 63
New Haven Hospital, Vacation Shore Cottage for Nurses of— Cox.. 344
New Instruments and Equipment 80, 153, 225. 347, 421, 500
New Jersey Hospitals Organize 401
New York City Hospital, Self-Government for Kesident Medical
StaflE of — Bacon 17
New York Department of Nursing and Health, Special Courses Of-
fered by, for Teachers and Supervisors 65
New York Institutions, Feeble-Minded Inmates of, to be Sifted Out. 5
New York Social Service Exchange 145
New York, State of. Women's Hospital (Ab.)— Gofte 222
Night Supervisor, Graduate, A Necessity (Q. & A.) loO
Nissley, Clarice — The Blue Triangle Hut 416
Nurses* Aid : See also Attendant.
Nurses' Aids, A Plea From the Front For (Ed.) r'H?.
Nurses' Appeal for, from Red Cross Department of Nursing (Ed.).. 288
Nurses' Association. Michigan State, Annual Meeting of 48
Nurses, Community, and Nurses, Public Health ; See Public Health
Nurses.
Nurses' Homes —
Mount Sinai Hospital, Nurses' Home of — Robinson 454
New Haven Hospital, Vacation Shore Cottage for Nurses of — Cox. 344
Nurses, Red Cross, Enrollment of 303
Nurses, Summer Preparatory Course for, at Western Reserve Uni-
versity—Wheeler 486
Nurses, Superintendents of. Duties of (Q. & A.) 221
Nurses, Trained, Canadian Association of. Meeting of 46
Nurses, Training of. How Colleges Can Help in— Stewart 483
Nurses, Training of, in Military Hospitals (Ed.) 114
Nurses, Vacation Cottage for— Cox 344
Nursing. Army School of 50, 290, 410, 413
Nursing, Department of 50, 138, 204, 303, 410, 483
Nursing in Civil Hospitals, The Relation of the War Program to —
Nutting 339
Nursing Problem : Third Year Training Under Government Super-
vision (Corr.)- Korndoerfer 202
Nursing Program of the Army — Goodrich 410
Nursing, Public Health : See Public Health Nursing.
Nursing Resources, Nation-Wide Survey of (Ed.l 389
Nursing, Schools of. Standard Curriculum for — Welsh 503
' sing. School of. Plan and Equipment of Model Teaching Unit
for
Nursing Service, Hourly, as a War M
Nursing, Teachers and Supervisors of, Speci;
by New York Department of Nursing a
Nutting, Adelaide— The Relation of the Wa
in Civil Hospitals
.138
(Corr.)— Hamilton... 78
Courses for, Olfered
1 Health 65
Program to Nursing
338
Obstetrics and the Hospital— Paddock 291
Occupational Therapy —
in Canadian War Hospitals— Burnette 401
in Kalamazoo State Hospital, Mental 458
in Mental Hospitals 45
in Nervous Disorders— Luther 11
in Sheppard and Enoch Pratt Hospital, Towson, Baltimore 458
National Society for Promotion of. Second Annual Meeting of. . .298
Occupational Therapy, Vocational Reeducation and Industrial Re-
habilitation 74, 145, 210, 295, 401, 476
Ochsner, A. J.— The General Hospital 124
Ohio Hospital Association, Fourth Annual Convention of 43
Ohio State Sanitorium. Mount Vernon, Ohio, Employment of Prison
Labor on— Douglass 99
Operating Room, Green, Saint Luke's Hospital, San Francisco —
Sherman 97
Operating Room, Redecoration of (Q. & A.) 150
Operating Rooms, Cleaning of, after Septic Operations (Q. & A.).. 420
Operation Barrack of Board of Surgical Ambulances of the Army
( Ab.) 222
Orphan's Home, St. Anthony. Newfoundland 63
Pagliani, L. — The New Lying-in Hospital at Arezzo (Ab.) 222
Paddock, Charles E.— Obstetrics and the Hospital 291
Painter, F. M.— Extending the Influence of a Hospital 355
Painting Hospital Wards (Q. & A.) 420
Parallax Foreign Body Localizing Instrument 347
Parker Hill, Boston, Reconstruction Hospital No. 10 148
Pay Clinics, Evening — Warner 143
Pennsylvania, Aid for Crippled Soldiers, Sailors and Marines of.... 297
Perry, N. V.— Details of Hospital Construction 469
Physicians, Enrollment by. Not Suspended (Ed.) 188
Physiotherapy as War Work for Young Women 416
Pitcher, Charles S. — Food Waste in Hospitals 491
Pneumonia Ward of American Red Cross Hospital, Liverpool, Eng-
land ''29
Pons J B. — Sanatoriums for the Tuberculous in the West of the
United States ( Ab.) 223
Porter, Charles A. and Carter, Herbert K. — Hospital Account-
ing 102, 173, 266, 371, 448
Power Plant and Heating Economies for Hospitals — Kimball 437
Practical Papers, Some ( Ed. ) 31
Presbyterian Hospital, Chicago 27
Presbyterian Hospital, Chicago, Economies in — Bacon 430
Prince, Ethel Anderson— Mental Hygiene and the War 196
Prison Labor, Employment of, on State Sanatorium Farm — Doug-
lass 99
Psychopathic Hospital of the Laboratory of Social Hygiene, Bed-
ford Hills. rAb.l— Davis and Southard 499
Public Health. Increased Need for Care of (Ed.) 288
Public Health Nurses, Illinois Course for 49
Public Health Nursing and Social Work. South's First School of —
Hibbs 147
Public Health Service, U. S., and Epidemic Influenza— Blue 423
Public Health Work in Cincinnati— Dinwiddle 180
Purchasing, (Centralized, as an Aid to Hospital Economy 107
Purchasing, Hospital, Associated Method of. Adopted by Austra-
lian Institutions (Corr.) — MacLennan 346
Pusey and Jones, Influenza Relief Work of — Hersey 490
Quarantine Stations at Didam, Sittard and Venloo (Ab.) 251
Queries and Answers 79, 150, 221, 420
R
.480
Reconstruction Aides, Emergency Training for
Reconstruction from War and Industry, Discussion of, by American
Association of Industrial Physicians and Surgeons 133
Reconstruction Hospital, First, Cornerstone of. Laid 148
Records, Hospital —
Efficiency System for the Medical Work of State Hospitals —
Singer 260
Hospital Clinical Records, Method of Indexing — Byrne 86
Red Cross-
American, Nursing Program of — Delano 336
American, Work of, in Repairing Facial Defects— De Monclos. . . 158
Canadian, Work Accomplished by, in 1917 49
Convalescent House at Walter Reed Hospital 217
Dietitian Service — Conley 407
Hospital, American, London 101
Hospital, Edward L. Trudeau Institution in France — White 247
Hospital. Pneumonia Ward of, Mossley Hill, Liverpool, England.. 429
Institute for Crippled and Disabled Men — McMurtrie 76,145
Nurses, Enrollment of 305
Quick Action of, in Influenza Epidemic 392
Work, Executives in. Need for (Ed.) 34
Work in India 168
Red Triangle Tuberculosis Farm Colony (Ab.) 222
Rehabilitation and Reconstruction Work of Canada — Kidner 393
Reid Memorial Hospital, Richmond, Ind 284
Resolutions Presented by the Resolutions Committee of the Ameri-
can Hospital Association 328
Re-use Knitted Gauze Dressings 347
Robert W. Long Hospital, Indianapolis 285
Robinson, Max'garet J. — Little Journeys to Places and People Worth
Knowing 23, 108, 183, 281, 454
Ronzani, E. — The Care of Convalescents in the (jspedale Maggiore
of Milan (Ab.) 152
Roosevelt Hospital, New York City 384
Rotating Service, Abolition of. During the War (Ed.) — Goldwater. .115
Royal Navigation Company, Java, New Hospital for 302
Ruhl, Mary R. — Inexpensive and Serviceable Wardrobes 294
Rural Communities, Hospital Service in (Ed.) 464
Rutledge. J. A. — A Fraternal Institution for the Free Treatment
of Tuberculosis 155
Sacred Heart Hospital, Fort Madison, Iowa 29
Safety Electric Warming Pad 153
St. Anthony, Newfoundland, Children's Home in 63
St. Anthony's Hospital, Carroll, Iowa — Robinson 108
St. Dunstan's Hostel for the Blind— McCallin 295
St. Francis Hospital, Waterloo, Iowa 112
St. John's Guild, Floating Hospital of. Again at Work — Beckman... 92
St. John's Hospital in Turin, Radiologic Division of 496
St. Joseph's Hospital, Ottumwa, Iowa 112
St. Luke's Hospital, San Francisco. Green Operating Room in — Sher-
man 97
St. Luke's Hospital, Chicago 27
Sanatorium, State, and the Labor Problem — Douglass 99
Sand, Rene — How America May Help Belgium After the War 256
Sandy, William C— The Standardization of Hospitals for the In-
sane 6
Sargent Water Still 80
Saskatchewan, Schools of. Medical Inspection in 301
School Medical Inspection in Saskatchewan 301
Segard, M. — How to Prescribe Rest and Exercise for Patients with
Pulmonary Tuberculosis ( Ab.) 152
Senior Pupil Nurses, Enrollment of, for Military Service (Ed.) 190
Shanahan, William T.— Institutions for the Care of Epileptics 364
Sharon Sanatorium, Children's Pavilion at, (Ab.)— Bowditch 222
Sheppard and Enoch Pratt Hospital, Towson, Baltimore 458
Sherman, Harry M. — The Green Operating Room at St. Luke's
Hospital, San Francisco 97
Shilt, Nell — The Conservation of Gauze 66
Ship Building, Welfare of Workers in 299
Ship, Hospital, U. S., Mercy 213
Simpson, F. F. — A War Program of Vital Importance 278
Singer, H. Douglas — An Efficiency System for the Medical Work of
State Hospitals 260
Small Hospitals, Affiliation for (Q. & A.) 160
Small Hospitals-
Agatha Hospital, Clinton, Iowa 29
Ashland General Hospital, Ashland, Wis.— Dodd 264
Brookville General Hospital— Bailey 165
Cottage Hospital, Creston, Iowa 112
Evangelical Deaconess Hospital, Marshalltown, Iowa 29
Jefferson County Hospital, Fairfield, Iowa 187
Kerrville Sanitarium Hospital, Kerrville, Texas — Harrison 58
Sacred Heart Hospital, Fort Madison, Iowa 29
St. Anthony's Hospital, Carroll, Iowa— Robinson 108
St. Francis Hospital, Waterloo, Iowa 112
St. Joseph's Hospital, Ottumwa, Iowa 112
Tuberculosis Sanatorium Buildings, Small, Planning of — Burt.... 1
Smith-Sears Bill, Passage of 147
Smith, Winford H. — Some Aspects of the Program of the Medical
Department of the Armv and Their Effect on Civil Hospitals. . .335
INDEX
Social Service—
and Hospital Efficiency — Warner 342
and the Influenza Epidemic (Ed.) 390
Exchangre of New York City 145
Made a Part of Nurses" Training at Louisville City Hospital 206
Social Work and Public Health Nursing, South's First School of.. 147
Social Workers, Hospital, American Association of 205
Social Workers, Hospital, First General Meeting of 343
Soldiers, Tuberculous, Rehabilitation of 46
Southard, E. E. and Davis, Katherine—Psychopathic Hospital of the
Laboratory of Social Hygiene, Bedford Hills (Ab.) 499
Spanish Influenza; See Influenza.
Spray Heater. Electric 422
Sputum Cup 153
St.: Sec under Saint.
Staff, Hospital, Resident, Self-Government for — Bacon 17
Staff, Hospital, Written Versus Oral Instruction for (Q. & A.) 221
Standardization of Hospitals —
Epileptics, Institutions for Care of — Shanahan 364
Insane, Hospitals for — Sandy 6
Standardization of Hospitals — Drew 56
State Hospitals — Bowen 81
Standardization of Staff and Hospital (Ed.) 117
Stanford University Medical School, Adolescent Clinic or (Ab.) —
Gales 151
State Hospitals, Efficiency System for the Medical Work of — Singer. 260
State Hospitals, Standardization of — Bowen 81
State Institutions, Well Directed Offensive Against Political Jobbery
(Ed. ) 288
State Sanatorium and the Labor Problem — Douglass 99
Sterilizing Machine, Large Portable, for Pershing's Troops in
France 218
Stevens, Edward F.— Memorial Hall of Buffalo General Hospital.. 20
Stewart. Isabel M.— How the Colleges Can Help in the Training of
Nui-ses 483
Stock Yards Community Clearing House, Influenza Relief Work of
(Corr.) — Bradshaw 497
Sun Treatment : See Heliotherapy.
Surgical Dressing Squads. Life-Saving, in France — Crawford 178
Surgical Needles, Need of (Ed.) 389
SuperT.-isor, Night Graduate, A Necessity (Q. & A.) 150
Suprapubic Drainage. Bottle for 225
Sutton. Mrs. Peggv Ann and Her Quilt (Corr.)— Farmer 200
Syphilis Clinic of Emery University, Atlanta, Georgia (Ab.) — Emery. 152
Tange, A. — The Mayo Clinics at Rochester, Minn., (Ab.) 222
Technicians, Laboratory, needed (Ed. I 32
Tent, Hospital, Six Hundred-Bed, Prepared in Twenty-five Days —
Watson 195
Tent Ward, Brooklyn Navy Yard Hospital 218
Test-Tube Boiler, Electric 154
Thermolite Heat and Light Infuser 153
Thompson, St. Clair — ^The Value and Limitation of Sanatorium
Treatment for Tuberculosis (Ab.) 224
Tilmant, M. and Nemirovsky, M. A. — Radio-Chirurgical Aeroplane
( Ab.) 499
Toilet Seats. Sanitary (Q. & A.I 420
Training Schools : See Nursing, Schools of.
Trains. Hospital, for Americans in France 218
Trolley, Hospital Ambulance, First 98
Tuberculosis Dispensary, Hygienic Work of (Ab.) 500
Tuberculosis, External, Hospital in Ilbarritz for (Ab.» 497
Tuberculosis, External, Treatment of by Heliotherapy 476
Tuberculosis Farm Colony, Red Triangle (Ab.) 222
Tuberculosis Hospitals, Permanent, Building of. Approved 193
Tuberculosis, Pulmonary, Hospitalization of, Buenos Aires (Ab.) —
Coni 222
Tuberculosis, Pulmonary, Rest and Exercise for (Ab.) — Segard 152
Tuberculosis Sanatorium Buildings, Small, Planning of — Burt 1
Tuberculosis, Sanatorium for, in the West of the United States (Ab.)
— Pons 223
Tuberculosis Sanatorium "Santa Maria," (Ab.)— Cabret 223
Tuberculosis Sanatoriums —
Barlow Sanatorium, New Four-Patient Cottage at — Klotz 378
Edward L. Trudeau Institution in France — White 247
Modem Woodmen of America Sanatorium, Woodmen, Col. — Rut-
ledge 155
Tuberculosis Sanatoriums in High Altitudes and on the Plains (Ab.).497
Tuberculosis, Surgical, Heliotherapy and X-Ray in Treatment of. .263
Tuberculosis, Value and Limitations for Treatment of (Ab.) — Thomp-
• son 224
Tuberculosis Work for Soldiers, Organization of, in France (Ab.)...498
Tuberculosis Work in Argentina— Coni (Ab.) 499
Tuberculous Soldiers, Care of (Ab) 496
Tuberculous Soldiers, Rehabilitation of 46
Tuley, Henry Enos — Some Problems of Hospital Management 169
Typhoid Patients, Hospitalizing of — Lebredo 224
u
United States Public Health Service: See Public Health Service,
U. S 423
United States Shipping Board, Emergency Fleet Corporation, Wel-
fare Work of 299
United War Work Campaign 419
Universal Service, Compulsory— Ministry of Health, A (Ed.) 33
V. A. D. in a French Hospital 212
Vancouver General Hospital, Military Annex of — MacEachern 257
Vancouver General Hospital, War Time Economies in — MacEachern. 66
Van Der Bent, T. J. — War-Time Hospitals Present Ideal Conditions
for Investigation 279
Vassar's Response to the Nation's Need for Nurses— Gray 204
Vassar Training Camp, Students of. Assigned to Duty 305
Vegetables and Fruits, Dehydrated 142
Venereal Disease Clinics— Davis 436. 481
Ventilator, Light-Proof , Dark-Room 500
"Verithin" X-Ray Cassette 80
Visitors and Visiting in Hospitals— Geffen 61
Vocational Instructors Needed in Military Hospitals 405
Vocational Therapy: See Occupational Therapy.
Volunteer Medical Service Corps (Ed.) 287
Volunteer Medical Service Corps — Martin 275
w
Walter Reed Hospital. Red Cross Convalescent House at 217
Wardrobe, Inexpensive and Serviceable — Ruhl 294
Wards. Hospital. Painting of (Q. & A.) 420
War Industries Board and Hospital Supplies (Ed.) 462
War: Its Hospital, Medical and Nursing Aspects 68, 148, 212, 416
War Service. Another Staff Member Called for (Ed.) 290
War Service Committee Conference 35
War Service Committee of American Hospital Association, Report of .332
War-Time Hospitals. Possibilities of Investigation in — van der Bent. 279
War-Time Institution Economies 66. 220
Warming Pad, Safety Electric 153
Warner. A. R.— Educational Work For Children at Lakeside Hospital. 354
Evening Pay Clinic 143
Social Service and Hospital Efficiency 342
Warner, Andrew R. and Davis, Michael M. — Dispensaries, Their
Management and Development (Bk. Rev.) 498
Who Should Be Dispensary Patients? 64
Warner. Mrs.. Death of (Ed.) 390
Warning to Hospitals Against Pretended Representatives of Modem
Hospital 391
Washburn, Frederick P.— The Nurses' Home of the Hackensack
Hospital 84
Water-Bath, Portable 225
Water Still, Inexpensive — Bacon 274
Water Still, Sargent 80
Weber. J. J.— Health Work of Dennison Manufacturing Company.. 488
Weber, .1. J.. Work of 59
Welsh. Mabelle S.— Standard Curriculum for Schools of Nursing 302
West Suburban Hospital, Oak Park, III 27
Western Reserv^e University, Summer Course for Nurses at —
Wheeler 486
Wheeler. Claribel A. — Summer Preparatory Course for Nurses at
Western Reserve University 486
White, Wm. Charles— The Edward L. Trudeau Institution in France. 247
Whitehill, G. E.— Organized Provision for the Care of the Sick in
Massachusetts (Ab.) 224
Wood, Derwent. Work of, in Repairing Facial Injuries 148
Woodward Gauze-Rolling and Folding Machine 421
Women Hospital Superintendents. Training and Rewards of (Ed.).. 387
Women's Hospital in the State of New Y'ork (Ab.)— Goffe 222
Workmen's Compensation. Health Insurance and Hospitals— Howell. 414
Wounded of Biffi Pavilion, Instruction for (Ab.)— Medea 222
Wright. Howell — Report of the Legislative Committee, American
Hospital Association Meeting, Atlantic City, New Jersey 329
X-Ray Cassette, Mcintosh, "Verithin" 80
X-Ray Operators, Protective Glasses for 226
X-Rays and Heliotherapy in the Treatment of Sui-gical Tuberculosis. 263
THE MODERN HOSPITAL
A Monthly Journal Devoted to the Building, Equipment, and
Administration oj Hospitals', Sanatoriums, and Allied Institutions,
and to their Medical, Surgical, and Nursing Services
Vol. XI
////j, 1918
No. 1
THE PLANNING OF SMALL TUBERCULOSIS SANATORIUM BUILDINGS
Wise Economy a Duty in Employment o£ Public Funds — Attractiveness, Durability,
and Convenience Attainable at Low Cost — Plans Drawn for Use of New York
State Department of Healtb
By JAMES D. BURT, Architect, New York.
WRITTEN across the top of the New York
State Department of Health letter-heads is
the slogan: "Public Health Is Purchasable.
Within Natural Limitations Any Community Can
Determine Its Own Death Rate."
This claim, startling and ambitious as it may
appear, has proved true by demonstration in the
results of the various activities of progressive
health departments in our own as well as in for-
eign countries ; it would appear that the statement
is not a boast, but a well-settled and generally ad-
mitted fact.
"How much is the cost?" is a natural question
to ask when a statement is made that a thing can
be purchased. If the cost of a thing is exorbitant
and beyond the ability of the would-be purchaser
to pay, then no purchase is made and the dan-
gerous condition is not remedied : Public health
must he made purchasable at a reasonable price.
What are the things which call for the outlay
of money in connection with this purchase of
health ? Doubtless professional and expert advice
and direction are a necessary and preliminary
part of the expense of public health. We are con-
cerned, however, in this article, only with that
part of the outlay which applies to the building
and equipment for the treatment of cases of
tuberculosis.
Because the treatment of tuberculosis is so
largely hygienic — the living of a normal life un-
der favorable conditions — a large part of the first
cost is represented by the necessary buildings and
equipment ; it is in the economy, or the lack of it.
as applied to this part of the outlay that deter-
mines whether or not health may be purchased
at a reasonable cost.
In these days of multiplied social activities,
when the community and the state are assuming
control of and responsibility for the prevention
and treatment of communicable diseases, in addi-
tion to various other social interests, it is becom-
ing more and more urgent that money raised for
these purposes shall be wisely used and made to
perform its work as efficiently as possible in jus-
tice to those who willingly or unwillingly are
taxed to meet the financial burden thereby im-
posed.
Economy and good judgment have not always
characterized the expenditure of public funds,
even when so important a matter as the public
health is at stake; we still have with us a con-
siderable number of those who consider a public
enterprise as an occasion of very liberal expendi-
ture of money, if not an opportunity for actual
plunder. One does not have to go far to find glar-
ing examples of buildings and equipment which
are monuments of wastefulness and inefficiency.
There is not only no excuse for this, but, in
view of the many sufferers who ought to be cared
for in sanatoriums, but who cannot be received
because of lack of room or the high cost of
treatment, it becomes a crime and no building
committee or board of supervisors is justified in
spending more than a reasonable amount for
their ouildings and equipment — such an amount
as, when placed in the hands of a trustworthy and
THE MODERN HOSPITAL
competent architect, will produce structures that
are at once attractive, economical, durable, and
convenient.
Applying this to the specific matter of the build-
ing or buildings for a small tuberculosis sanato-
rium, we shall endeavor to illustrate a few simple
and commonplace principles which experience has
taught us to observe if the foregoing four requi-
sites are to be secured.
The matter of appearance and general attrac-
tiveness should receive at least as much attention
as the design of a private residence of equal cost.
The institution is to be the home, for the period
of their treatment, of many who come to it under
peculiarly adverse circumstances, and it is left to
the environment, both physical and social, as well
as to fresh air, sunshine, and good care, to estab-
lish and to maintain the feeling on the patient's
part that he has come to the place where health
is to come again, and where for the time, to as
great extent as possible, all care and anxiety are
to be dissipated.
Nor is it necessary to be extravagant in order
to make a building attractive. Usually, and partic-
ularly in such a building, simplicity is the keynote
of attractiveness ; plenty of sunlight and air with
ample opportunity for yet more air, with protec-
tion from cold winds ; quiet, cheerful colors ; a
pleasant outlook; opportunity for privacy, so far
as may be, with all physical needs easily provided
for — these are all a part of the general attactive-
ness which appeals to the average patient.
As for economy of construction, of course there
is an economy which might better be called parsi-
mony, for no method of construction which has
only low initial cost to recommend it can be justly
called economical if the usefulness of the building
will be of short duration and it must soon be re-
paired or replaced. The matter of strength and
durability should be more accented in public or
semipublic institutions than in private buildings,
for the reason that they are given harder usage
in spite of the greatest watchfulness. There will
always be a certain number of persons who will
never catch the spirit of personal responsibility
in the use of public property.
The matter of wise, economical construction
and equipment may well be a matter for coopera-
tion on the part of the architect and the hospital
board.
Convenience in layout is a very important mat-
ter, on the score both of general utility and satis-
faction and of the cost of administration. A
building correctly planned and equipped will save
the services of one or more persons over a build-
ing that is poorly planned, thus avoiding a per-
petual loss and a constant irritation.
The example here illustrated is selected from
a number of model or typical plans designed
for the New York State Department of Health,
and intended as a guide in the designing and con-
struction of the various county tuberculosis hos-
pitals which, under the recently enacted law, must
be erected in all counties with a population of
35,000 or more which are not already provided
with adequate accommodations for tuberculous
patients. The present commissioner of the de-
partment. Dr. Hermann M. Biggs, an acknowl-
edged international authority on all matters re-
lating to the study and treatment of tuberculosis,
from the beginning of his activities regarding
public health in general and tuberculosis in par-
ticular, has been very pronounced in his insistence
on the dissemination of all that has been learned
THE MODERN HOSPITAL
relating to the causes and treatment of this dread
disease. The best advice and suggestions have
been available for the asking ; if there is any per-
son of understanding of any nationality in this
These drawings are a part of the liberal propa-
ganda in this war against tuberculosis ; the maker
of them does not pretend that they are a perfect
solution of the problem of sanatorium construc-
Fig. 2. basement pi;
A. Washing machines
B. Soap tank,
C. Extractor,
D. Wash trays.
E. Starch kettle.
F. Table.
G. Dryer.
H. Ironers.
I. Folding table.
J. Incinerator.
K. Hot water heater.
L. Heating boiler.
M. High-pressure boiler.
N. Vacuum cleaner machine.
O. Sputum depository,
P. Dumbwaiter.
Q. Coffee and tea urns.
R. Dish shelves.
S. Dish washer.
T. Garbage cans.
U. Vegetable peeler.
V. Vegetable preparation.
W. Baker's table and bins.
X, Baker's proofer.
Y. Cabinet (
Z. Vegetable cooker.
AZ. stock pot,
BZ, Range.
DZ. Cook's table.
EZ. Steam table dish
warmer.
FZ. Meat block.
1. Laundry.
2. Receiving room.
3. Clean linen room,
4. Coal
5. Boiler
6. Toilet.
7. Women's toilet.
8. Sto
9. Vestibule.
10. Stair hall.
11. Help's dining room.
12. Kitchen coal.
13. Kitchen and bakery.
14. Serving pantry.
15. Refrigerator vestibule.
16. Meats.fish.
Milk, butter, eggs.
Recreation i
Sewing and mendii
Medical laboratory.
Business office.
General hall.
, Physicians' office.
Examination room.
Staif pantry.
Staff dining room.
Patients' dining rot
Entrance porch.
1. Open wards.
2. Sitting rooms.
3. Dressing rooms,
4. Lavatories.
5. Toilets,
6-15. Men help's quarters.
?. Attendants' toliet.
(. Supplies, linen, etc.
i. Nurses' room,
i. Stair hall,
). Rear porch.
I. Unassigned.
22. Diet kitchen.
23. General corridor.
24. Book shelves.
25. Linen closet.
26. Bed patients' hall.
27. Closet.
28-33. Bed patients' quarters,
34. Bed patients' porch.
A. Bath tubs.
B. Showers.
C. Dental lavatory,
D. Wash basins.
E. Slop sinks.
F. Utility sink hoppe
G. Water closets.
H. Dumbwaiter,
I. Shelves.
state who does not to some extent appreciate the
malignant nature of this disease and the steps to
be taken towards a cure, he has deliberately shut
his eyes and his ears so that he could not see and
hear the evidence and the testimony regarding it.
tion, but they do contain some principles which
should be included in the layout of every tubercu-
losis hospital, whether large or small.
Tne controlling idea in these plans is to provide
for fifty cases of incipient tuberculosis with the
THE MODERN HOSPITAL
usual proportion of bed patients, together with
the staff and all helpers needed in the institution,
with as little outlay as possible under the circum-
stances and without the sacrifice of any desirable
feature or detail.
It is assumed that the site is on a hillside slop-
ing toward the south, protected from the north
and west winds by the rise of the hill behind. This
1. Entrance halls and corridor.
2. Business office — stenographer, mail, etc.
3. Physicians' office — patients, records, etc.
4. Examination room — nose, throat, etc.
5. Medical and laboratory room.
6. Reception room or general waiting room.
7. Linen closet.
8. Broom clor.et.
9. Staff toilet for men.
1. Open sleeping wards.
2. Sitting rooms.
3. Dressing rooms.
4. Lavatory.
B. Toilets.
6. Attendants' toilet.
Fig. 4. Second floor of the :
fifty-bed tuberculosis hospital.
7. Supplies, linen, etc.
8. Nurses' room.
9. Stair hall.
10. Help's sitting room.
11. Diet kitchen.
12. General corridor.
13. Bed patients' hall.
14. Linen closet.
16. Closet.
16-21. Bed patients' quarters.
22. Bed patients* porch.
23. Book shelves.
24. Fire escape.
A. Bath tubs.
B. Showers.
C. Dental lavatory.
D. Wash basin.
E. Slop sink hopper.
F. Utility sink.
G. Water closet.
H. Dumbwaiter.
I. Shelves.
3"
'-£]
Fig. 5. Third floor of the tuberculosis sanatorium.
7. Servants' room.
8. Servants' room.
9. Servants' room.
10, Stenographer.
11. Stair hall.
12. General corridor.
13. Servants' linen.
13 A. Slop sink closet.
14. Nurses* linen closet.
15. Head nurse and matron.
1. Roofs.
2. Servants' room.
3. Servants' room.
4. Servants'room, toilet.
5. Servants* room.
6. Servants' room.
allows the placing of the main entrance in the
basement about on the level of the ground in front,
giving full windows on the south, avoiding a num-
ber of outside steps to a first-floor front porch,
and leaving the entire front porch of the first and
second floors available for patients.
The rooms and accommodations actually needed,
allowing for slight modifications one way or the
other, are as follows:
16. Bathroom.
17. Nurses' room.
18. Nurses* room.
19. Nurses' room.
20. Nurses* room.
21. Nurses' room, toilet.
22. Roof over porch.
23. Physicians' quarters.
24. Physicians' quarters.
25. Physicians' quarters.
10. Staff toilet for women.
11. Patients' dining room (15 square feet for each).
12. Serving pantry.
13. Kitchen, bakery, and preparation room.
14. Refrigerating room.
15. General storeroom, vegetable cellar, etc.
16. Staff dining room, accommodations for eight persons.
17. Staff pantry.
18. Help's dining room — sink, dish cupboard, etc. Ac-
commodations for twelve persons.
19. Help's toilet for men.
THE MODERN HOSPITAL
20. Help's toilet for women.
21. Heating plant and coal storage.
22. Sputum destroyer — incinerator.
23. Laundry.
24. Workroom — mending, repairing, sewing, etc.
25. Recreation room and library for patients.
26. Mortuary.
27. Trunk room — suit cases.
28. Living room, bath, bedroom for physicians.
29. Living room, bath, bedroomfor matronand headnurse.
30. Nurses' bedrooms for six nurses.
31. Stenographer's and bookkeeper's bedroom.
32. Sitting room for nurses.
33. Baths and toilets for nurses.
34. Servants' (women) bedrooms for nine women.
35. Sitting room for servants.
36. Baths and toilets for servants.
37. Men workers' bedroom for three men.
38. Baths and toilets for men workers.
39. Open wards — stalls for each two patients.
40. Living room for patients, 20 square feet to each
patient.
41. Dressing rooms 3 by 5 feet, one for each patient.
42. Baths — toilets for patients.
43. Blanket warmer, a fixture 2 by 4 by 6 feet high,
coils under shelves.
44. Bed patients' quarters (20 percent and above of
total number of patients) .
45. Baths and toilets for bed patients.
46. Separate corridor or hall for bed patients.
47. Room for nurse in charge.
48. Diet kitchen.
49. Supply room — linen, etc.
50. Vacuum cleaner system by motor in basement.
As to the matei'ials to be used in the erection of
this building, in order to secure the desideratum
of economy and durability, this is largely a matter
of local availability and cheapness. Where good
lumber is to be had in quantity, the argument
would be in favor of a frame building modified to
make it as safe as possible from fire risk, whereas
in a locality where stone and sand may be ob-
tained cheaply, the type of construction would
naturally be of masoniy or concrete. This mat-
ter may safely be left in the hands of a judicious
architect. The cost of the building is naturally
governed by the materials used and the expense
of assembling them; local rates of wages; these
fluctuate greatly, especially in these war times.
The principal reasons for including under one
roof the various activities of an entire sanatorium
are the economy of first cost and ease of adminis-
tration. There are good arguments in favor of
building a group of three or four buildings for
even so small a number as fifty patients. It is
the endeavor to illustrate here the cheapest solu-
tion for the problem compatible with satisfactory
provision for the treatment of tuberculous pa-
tients, leaving to individual and specific cases the
expansion of the principles thus set forth.
The details of construction should be such as
have been proved best in hospital building. There
are many minor points in this connection which
become important when a plant is in operation,
and which may be overlooked by an architect who
has not had some experience in hospital construc-
tion; the so-called major matters are not so apt
to be neglected.
It is unnecessary to explain in detail by text the
points to be considered ; they are apparent by ref-
erence to the accompanying plans. Exception
may be taken to the number of persons constitut-
ing the staff and coi-ps of helpers for whom quar-
ters are provided. Those who are unfamiliar with
the operation of such a sanatorium have raised
the question. There may be localities where espe-
cially favorable conditions enable the institution to
obtain certain unskilled help in the immediate
neighborhod by the day, but the number here pro-
vided for, or closely approximating it, has been
proved by extensive experience to be necessary if
the institution is to be well served.
Finally, although advocating economy, we
strongly advise against that false economy which
tends to count a thing cheap because its first cost
is low; perhaps in no other kind of building is
this so great a fallacy. On the other hand, a thing
is not good because it is high in price. There is
at every step abundant opportunity for the exer-
cise of judgment and discrimination in the outlay
of money for professional services, and labor, for
materials, and for equipment.
If all our hospitals and sanatoriums are erected
with judicious economy as a guiding principle, it
will aid materially in stamping out or in bringing
under control diseases against which progi'essive
thinking and public-spirited men and women have
long labored with a good measure of success, but
whose unselfish eflforts will be multiplied when
the money available is made to do full duty in pro-
viding for a greater number without additional
outlay.
To Sift Out Feeble-Minded Inmates of New York
Institutions
Governor Whitman of New York has signed the Sage-
Machold bill adding to the duties of the Hospital Develop-
ment Commission, which was created by the last legisla-
ture to formulate a systematic plan for more adequate
facilities for the insane and feeble-minded. The bill au-
thorizes the commission to make recommendations for a
reclassification of the inmates of state institutions, except
the prisons and the hospitals for the insane, with a \aew
to the segregation of the feeble-minded. This will enable
the development commission to make inquiry as to whether
the inmates of the various state institutions, a large per-
centage of whom are feeble-minded, should be reclassified
and one or more of the institutions be set aside for de-
fective delinquents. The need of accommodations for the
criminally inclined among the feeble-minded is one of the
most pressing phases of the problem. — S. C. A. A. News.
THE MODERN HOSPITAL
THE STANDARDIZATION OF HOSPITALS FOR THE INSANE*
Advantages of State Over Private and County Institutions — Importance of Fire Protec-
tion— Toilet Arrangements, Bathing, Heating, and Lidhtin^ — Governmental
and Administrative Conditions
By WILLIAM C. SANDY, M.D., Assistant Superintendent Connecticut Hospital for the Insane, Middletown,
Connecticut.
THERE is probably no special class of hospitals
in greater need of standardization than that
devoted to the care and treatment of the insane.
Vast sums are annually appropriated for the
maintenance of the public institutions for the in-
sane. From the standpoint of the taxpayer, every
effort must be made to establish methods of eco-
nomical care. It is of vital importance to the
public welfare, however, that such equipment
and facilities be furnished as will promote every
possible chance for restoration, and that provi-
sion be made for prophylactic measures. For it
should be generally recognized that the likelihood
of recovery may be increased, and recovery itself
hastened, by the application of proper methods
of treatment, and that in prophylaxis lies the
principal hope for the future in combating the
ever-increasing problem of the insane.
In general, there are three great classes of in-
stitutions for mental diseases — the private, the
county, and the state. The private hospitals,
usually called sanatoriums, occupy a peculiar and
special position, often providing the exclusive and
individual care which appeals to those who can
afford the high rates commonly demanded. There
are many well-equipped and admirably conducted
private hospitals where the most modern forms
of treatment and the best results may be ob-
tained. On the other hand, unfortunately, there
are privately conducted institutions, hospitals in
name only, with exorbitant rates and bare cus-
todial care, the standard being scarcely above
that of a first-class almshouse.
The county hospitals, aside from the few large
institutions which resemble in management the
state hospitals, are generally unsatisfactory. This
is, for the most part, due to a close affiliation with
almshouses and to political administration. The
limitations of this paper will not admit an ade-
quate discussion of these institutions with their
meager equipment, lack of treatment, and un-
trained medical staffs, all of which should be re-
garded as relics of the past.
The state hospitals, usually free from serious
political entanglements, with the resources of the
state behind them, are provided with larger staffs
♦This paper is the third in a series, by various authors, on the
standards of the various classes of special hospitals. The first, "Stand-
ards for a Children's Hospital,'* by Stafford McLean, appeared in the
May issue ; the second, "The Standards of Hospital Education for In-
terns," by J. M. Baldy, was published in June.
of trained physicians, better equipment, and more
scientific methods. It is the purpose of this paper
to consider the state hospitals and to outline
briefly what may be regarded as desirable and
possibly ideal, according to the present knowledge
in respect to equipment, methods, and the like.
In discussing the question of standardization
of state hospitals for the insane, one should bear
in mind the objects of such hospitals. While in
some sections of the country it is still customary
to use the term "asylum" and many of the institu-
tions are little better than the old custodial type,
the best modern hospitals for the insane have far
higher ideals and a broader scope. It should be
the aim of the hospital to restore, as soon as pos-
sible, the recoverable ; to prevent deterioration
and to endeavor to reeducate the so-called chronic ;
to treat successfully the physically ill ; to guard
against injury or accident, such as suicide; to
care for and make comfortable the excited, the
feeble, and the aged ; to hold those dangerous to
themselves or to the public ; to make such full
examinations and keep such complete records that
the work of the hospital will have present and
future scientific value; and, finally, through out-
side agencies, to be an active force for mental
hygiene. It is needless to say that all of this is to
be done in as efficient and economical a way as
possible.
Very little will be said as to the proper size of
institutions. This is purely a matter of theory,
the actual size of hospitals being largely deter-
mined by the exigencies of the situation. Econ-
omy and the increasing number of patients make
necessary, quite generally, large institutions.
While it is undoubtedly true that the average
executive will be more successful with hospitals
of two thousand patients or less, institutions of
over five thousand will be found to be efficiently
operated, depending upon the capability of the
administrator and his assistants.
In selecting the site for a hospital, preference
should be given to a location somewhat removed
from the large centers of population, in order
that sufficient ground for exercise, with desirable
privacy, may be obtained for the patients, and
also ground for a farm and garden large enough
to supply the necessary products for maintenance.
Some consideration also should be given to the
THE MODERN HOSPITAL
natural beauties and the hygienic qualities of the
site, and it is, of course, essential that it be well
drained and supplied with an abundance of pure
water. While avoiding large cities, it is desir-
able to have the hospital accessible to a small
town or city in order to insure the necessary
diversion for employees, the obtaining of whom,
at the present time, is an increasingly difficult
proposition. The hospital should be connected
with both steam and electric railways on account
of freight facilities and the convenience of visi-
tors and employees.
In the early days of state hospital construction,
the architectural tendencies were towards mass-
ive single buildings of monastery or prison-like
appearance, several stories in height and with
rather numerous but needless ornate features,
especially in the administration portions. While
attractive appearance should not be disregarded,
the substantial and fireproof qualities are far
more essential. The present tendency is more
towards detached groups of buildings. The so-
called cottage plan is probably the ideal, but is
not practicable except on a large scale, that is,
single buildings accommodating several hundred
patients. Farm colonies, utilizing more cheaply
constructed and temporary buildings, have dem-
onstrated their usefulness for the chronic, quiet
workers. In any case, buildings of more than
two stories are seldom, if ever, desirable.
Too much attention cannot be paid to fire pro-
tection. The above-mentioned old type of single,
lai'ge building, often a veritable firetrap, should
be remodeled so as to be divided up into several
units separated by fire walls and automatic fire
doors. Outside covered fire escapes of approved
type and inside fireproof stairways should provide
sufficient exits from every floor. These precau-
tions are indispensable, as are also outside hy-
drants, standpipes, and hose on every floor con-
nected with a water system of sufficient amount
and pressure supplemented by a fire pump for
emergency added pressure. All exit doors should
open outwards.
The interior plans of the buildings, an adequate
discussion of which would necessitate a volume,
will be covered only in a general way. An excel-
lent type of ward is one provided with a day room
connected with a fireproof porch, a large dormi-
tory for sleeping purposes, and a water section
with sufficient toilet and bathing facilities. Nec-
essary adjuncts are adequate clothes rooms, lock-
ers, and the like. The dormitory for sleeping
purposes, simplifying the night watch service, is
applicable in the case of most varieties of mental
disease, but a few single rooms are often desir-
able for certain violent, dangerous, or paranoid
individuals.
There should be a sufficient number of wards
or units to facilitate proper classification of pa-
tients based largely upon their demeanor and
physical condition. New patients and those who
may be convalescent, feeble, or of the quiet and
tranquil type, should not be subjected to the
annoyance and undesirable association with the
violent, destructive, noisy, and untidy. An idea
as to the requirements may be obtained from the
following estimated percentage of the different
classes. The acute or reception service may be
represented by 5 percent ; the hospital or physi-
cally ill, 2 percent; the chronic, quiet, and
clean, 28 percent; the disturbed and violent, 16
percent; the feeble, aged, and infirm, 20 percent;
working, 17 percent; tuberculous, 5 percent; epi-
leptic, 5 percent; convalescent, 2 percent. A de-
sirable feature, if possible, is a separate building
for the acute, reception, or as it is sometimes
called, psychopathic department, especially well
equipped for treatment, including an operating
room. The tuberculous also are preferably cared
for in separate and specially designed buildings.
In the matter of toilet arrangements, one seat
to ten, or at least fifteen patients, with twice the
number of wash basins may be considered a mini-
mum requirement. The hoppers should be of the
type which flush automatically when used. All
hot-water faucets should be provided with safety
devices to prevent patients from scalding them-
selves. Probably the simplest and safest way is
to have the hot water turned off and on by means
of a key with which the nurses and attendants
only are provided ; although theoretically the
plan sometimes adopted of having a thermostatic
attachment to the hot-water system is good.
The question of proper bathing facilities is one
only too frequently neglected. No longer should
bathtubs be deemed satisfactory equipment. It
is a regrettable but actual fact that, where tubs
are used as the sole method of bathing, many
patients may be bathed by careless or ignorant
attendants without changing the water. The only
safe and sanitary method is by showers, each
patient then being assured a clean bath, and a
large number being easily bathed in a short time.
Tubs are required for special cases, such as some
of the infirm, but shower baths are practicable
for the majority of patients, both men and
women.
Heating by direct radiation is probably, at the
present time, the most satisfactory method. All
radiators and hot pipes should be covered or
placed out of reach of patients who otherwise
8
THE MODERN HOSPITAL
might easily be burned. The heating system
should be combined with some method of auto-
matic forced ventilation.
Lighting should be by electricity with properly
protected wiring, the only special consideration
being that the turning on and off of the lights
should be under the control of the nurses and
attendants, by means of some key device.
It will suffice merely to mention certain other
indispensable departments and facilities which
for the most part do not acquire any new charac-
teristics by reason of the special nature of the
institution. Every hospital should have a proper
method of sewage disposal. Necessary depart-
ments are the kitchen, bakery, dairy, store, laun-
dry, the shop, e. g. carpenter, painting and me-
chanical, the cold storage and ice plant, the cen-
tral lighting, heat, and power plant.
Some thought should be given to the proper
housing of resident officers and employees. Com-
fortable quarters should be furnished, the hos-
pital service being for many a lifetime career.
There should be an employees' home with provi-
sions for single and married attendants and
nurses.
While the physical conditions of hospitals for
the insane present many peculiar problems, such
as have been briefly outlined, the governmental
and administrative conditions are even more spe-
cial in type and importance. Good work may
very likely be accomplished by capable men even
though handicapped by poor equipment, but surely
proper methods of government and administra-
tion are indispensable.
Most state hospitals are under the general
supervision of an unpaid board of managers or
trustees appointed by the governor. That this
board should be nonpartisan, free from petty
political entanglements, fairly secure in office,
and not subject to the liability of sudden removal,
in the event of change of administration, should
be self-evident. This may be accomplished by the
provision that the board shall be continuous, the
term of office of only a part expiring each year.
Among the various duties of the board should
be the close inspection of the finances of the hos-
pital— this final control of the expenditures, if
conscientiously carried out, assuring the safe-
guarding of the public's interests.
The selection and appointment of the resident
superintendent should be left largely in the hands
of the board of trustees, who alone should have
the power of removal, giving the executive officer
the security in office essential for effective work.
The primary aim of the hospital being medical,
there can be no question that the chief executive
officer should be a physician, one who has gained
his experience in psychiatry by actual residence
in hospitals for the insane, and who has demon-
strated the necessary executive ability. Many of
the difficulties preventing successful administra-
tion are due to frequent changes and the inexperi-
ence of political appointees. Divided and uncer-
tain authority will merely serve to hinder the
progress which is otherwise to be expected from
the activities of a capable executive.
The assistant officers and heads of departments
should be appointed by the board of trustees upon
the recommendation of the superintendent and
should be entirely under his direction.
Generally speaking, a desirable proportion of
physicians to patients is about one to two hun-
dred. The different services require a varying
number, the acute or reception, for instance, re-
quire more than the chronic. In the larger hos-
pitals there should be an assistant superintendent
and a clinical director, the duties of the former
being to relieve the superintendent of certain
routine matters, such as the help problem, those
of the latter being to supervise and correlate the
medical work. In the smaller hospitals these two
positions may very easily be combined.
There should be enough resident experienced
assistant physicians to take charge of the various
services. A requisite number of resident junior
assistants and interns are required to assure the
proper attention to routine details. The interns
may be only temporary officers serving largely
for the experience. The other members of the
staff, however, should, as far as possible, be reg-
istered physicians interested in the study of psy-
chiatry as a career. Every hospital for the in-
sane should have at least one woman physician
on the staff, chief among whose duties should be
to make those special examinations and treat-
ments so essential to the comfort and welfare of
the women patients.
A successful administration of the hospital will
depend largely upon the qualifications of the
heads of the departments. Executive ability and
expertness in the special field coupled with loyalty
and cooperation are essentials to be looked for.
A business manager, purchasing agent, or stew-
ard is required, one who is able to install modern
business methods, and who is qualified as a judge
and buyer of supplies. Other important positions
are storekeeper, farmer, engineer, head carpen-
ter, laundryman, and chef, all of which come
under the immediate supervision of the business
manager. There should be a matron whose duty
is the general supervision of the housekeeping and
the help therein engaged. More detailed discus-
THE MODERN HOSPITAL
sion of these and similar positions is not neces-
sary, as there are no very unusual conditions
liable to be met with in these departments, owing
to the special nature of the hospital.
The importance of having a sufficient number
of reliable nurses and attendants is self-evident.
It is in this department, however, that one of the
greatest difficulties is encountered, it being almost
impossible to secure enough help (in numbers)
without much regard to the quality. This has
become especial^7 true since the beginning of
the war because of the high wages offered by
munition and other industries. Many hospitals
have been brought to the necessity of hiring prac-
tically all applicants without regard to grade and
even then being twenty-five percent or more
short-handed. In view of the scarcity of appli-
cants, it is almost useless to state that there
should be at least one nurse or attendant to ten
patients, a proportion seldom possible at this time.
Especially on the reception and infirmary wards
for men, women nurses should be employed.
Where it is possible to secure enough competent
women nurses, they should be placed in charge
of other male wards, with resultant improvement
in the quality of nursing and housekeeping, and
less liability of ill-treatment of patients.
An adequate force of attendants and nurses
should be assigned to the night service, the mini-
mum requirements being, generally speaking, one
nurse or attendant to forty patients. In any
case, there should be a sufficient number of em-
ployees to permit the doors of a majority of the
patients' rooms to be unlocked at night. This ex-
pedient is exceedingly important from the stand-
point of fire protection alone, as is also the hold-
ing of regular fire drills of both employees and
patients, the former being taught the use of fire-
fighting apparatus, including hose and extin-
guishers, which should be plentifully supplied
throughout the hospital, and the quickest way of
getting the patients out of the buildings. In con-
nection with this, and for additional fire protec-
tion, it is well to have two fire companies com-
posed of outside employees and provided with
hose-carts, chemical apparatus, ladders, life-nets,
and so forth, and which hold regular, practical
drills. The existence of two companies, each with
a chief, will result in a wholesome rivalry and in-
creased efficiency. Besides the inside night serv-
ice, there should be enough outside watchmen to
insure the required order and safeguarding of
the buildings and grounds. As a check upon the
night service, a modern watchmen's clock system
should be installed, or both the inside and outside
night employees may be correlated by means of
a system of ringing in to a central office, such as
is found in a first-class police department. The
latter plan combines the desirable features of
both a watchmen's clock and a standard fire-
alarm system at probably no greater expense.
In immediate charge of the attendants and
nurses of each service should be a day and a night
supervisor who are the physicians' representa-
tives in respect to discipline, order, and direction.
The training school for nurses should be an im-
portant adjunct to every hospital for the insane.
While most of those in immediate charge of the
patients will be of the attendant class, perhaps
with considerable practical but with little theo-
retical knowledge as to proper methods, the pres-
ence of a good training school will mean that
there will be a certain number of the more intelli-
gent men and women undergoing instruction
which cannot fail to elevate the standards of care
and treatment. The quality of the instruction, of
at least two but preferably three years' duration,
should be such that with an additional post-gradu-
ate course in a general hospital, the graduate of
the training school may obtain state registration.
At the head of the training school should be a
competent superintendent of nurses, a graduate
nurse of recognized standing. The lectures should
be given by the members of the resident medical
staff. The ordinary attendants should also re-
ceive instruction in the more practical and neces-
sary branches in order that they may have a
proper conception of their duties.
While perhaps of less relative importance than
in the case of general hospitals, a well-stocked
pharmacy is required, presided over by a regis-
tered pharmacist. Much of the latter's time will
be taken up with prescription compounding, as
few drugs will be kept on the wards.
The efficiency of the medical work will depend
to a considerable degree upon the routine method
of examination and treatment prescribed for the
medical staff. Upon admission every patient
should be placed in bed in an observation ward
for a week or ten days, during which time a thor-
ough mental and physical examination should be
made. In the physical examination nothing
should be neglected. The ordinary laboratory
procedures, such as urinalysis, should be supple-
mented by such special examinations as that of
blood, sputum, gastric contents, feces, and so
forth, as may be indicated. A Wassermann blood
test should be done in each case with spinal fluid
examination where indicated. A detailed mental
examination, modeled after that recommended
some years ago by Adolf Meyer, should be made.
The results of the mental and physical examina-
10
THE MODERN HOSPITAL
tion are then to be typewritten in accordance with
a regulation form; the latter being necessary in
order that every item of importance in the pa-
tient's condition may be covered, for his own wel-
fare and so that the statistical and other records
may be made of the greatest possible future value.
This, of course, presupposes that adequate clerical
and stenographic assistance shall be available.
At staff meetings held daily, or frequently
enough for the accomplishment of the work, and
presided over by a clinical director or other com-
petent officer, each case history is to be read and
the patient presented in person in order that the
benefit of a full consultation as to diagnosis, treat-
ment, and other matters of importance may be
assured all patients admitted.
Space will not allow a detailed discussion of
certain other necessary facilities. To secure thor-
ough treatment for all, there should be proper
dietetic arrangements, surgical equipment for
any operation, a consulting staff of surgeons,
electrical apparatus for diagnosis and treatment,
a resident dentist with the required equipment,
and some provision for ophthalmological and
other special examinations when required.
No hospital for the insane is adequately pre-
pared without provisions for the application of
hydrotherapy. By hydrotherapy is meant treat-
ment by means of the continuous bath, the various
forms of wet-pack and special baths, such as the
needle, rain, shower, the different douches and
the like. The lack of hydrotherapeutic facilities
(associated also with an insufficient number of
attendants, too few wards for the proper separa-
tion of the disturbed, and faulty methods of treat-
ment) account to a great degree for the practice
in some hospitals of restraint and seclusion, which
no longer are countenanced in the best modern
hospitals except in extreme cases.
Occupation, when properly applied as a thera-
peutic agent in the treatment of the insane, not
only retards mental deterioration, in many cases,
but also frequently hastens recovery and serves
to prepare the patient for a return to his normal
environment. One or more full-time instructors
are required, and the various forms of diversional
occupation, such as raffia and reed basketry, rug,
brush and broom-making, knitting, crocheting,
tatting, embroidery, and the like, cement-work,
chair caning, and so forth, should be made avail-
able. Of great value, in the same way, and of
considerable economic importance are the oppor-
tunities for farm and garden work available to
the patients. Besides the foregoing, much of the
clothing, the shoes, the mattresses, and some of
the furniture may be made by patients under
supervision.
There should be a school with a teacher com-
petent to apply graded reeducational methods
helpful in certain classes of patients.
Recreation also is effective as a means of arous-
ing the interest and of combating the tendency to
dementia. No community is doing justice to the
insane in its care without providing forms of
amusement in the shape of dances, moving pic-
tures, baseball, and other kinds of games and en-
tertainments. There should be an athletic field
and also a fireproof assembly hall large enough to
accommodate a fair proportion of the patient pop-
ulation. Religious services should be held regu-
larly, presided over by clergymen of the various
denominations.
Some reference has already been made to labo-
ratory requirements. Every hospital should be
prepared to carry on, as routine measures, the
various tests so necessary as aids in diagnosis, not
only for mental disease but also for ordinary
physical ailments. The medical staff should be on
the alert to secure permission for post-mortem
examinations in the interest of science and the
welfare of humanity. Facilities should be pro-
vided for the proper study of the material ob-
tained. The laboratory ought to be in charge of
a trained pathologist with adequate assistants to
enable him to do research work.
One frequently hears of the "ever-widening in-
fluence of psychiatry," as a consequence of which
institutions for the insane and the officers con-
nected with them can no longer restrict their
activities to a small sphere of the "asylum," as
formerly designated. The facilities for advice,
observation, and treatment must Be extended by
the establishment of out-patient departments and
psychiatric wards in general hospitals in the large
centers of population. In this way, as is shown
by actual experience, thousands of persons may
be reached and benefited in the early and border-
line stages of psychosis development and restored
to mental health in a short time, avoiding what
is now so often wrongfully considered the stigma
of commitment in a hospital for the insane. The
frequently unwieldly, slow, and public methods
of commitment procedures, often treating a pros-
pective patient as a criminal, incarcerating him
in a jail, escorting him to the hospital, it may be,
handcuffed and in the custody of an officer, must
be replaced, so far as possible without endanger-
ing his constitutional rights, by prompt and expert
examination, care of trained attendants, and
quick and unobtrusive methods of conducting to
the hospital. The system of voluntary admission
THE MODERN HOSPITAL
11
must be extended, bringing within reach of many
patients, who themselves often realize the neces-
sity for treatment, the early care that insures a
brief residence at the hospital. Such facilities
are not only of great benefit to the patient, but
are really a matter of economy to the state, short-
ening the length of care in the hospital, conse-
quently lessening the expense and, it may be, re-
storing sooner a useful member to the com-
munity.
There should be a system of parole of suitable
patients by reason of improvement or recovery,
affording an opportunity for the trial return to
self-support for a period of some months, during
which time the patient may return to the hospital
for further care and treatment, without a repeti-
tion of the legal formalities, should it be deemed
necessary. The parole system should be com-
bined with an efficient after-care agency, prefer-
ably a member of the medical staff or a social
worker, who may have a certain amount of super-
vision over the paroled patient. Such an after-
care w^orker may render service in advising the
return of the patient, if indicated, in assisting in
a change of habits or environment, in helping to
obtain a suitable position, in arousing a kindly.
helpful attitude toward the former patient, in com-
bating the feeling of suspicion or lack of confi-
dence so often met with, and in adjusting difficul-
ties in the home, family, or environment which
otherwise might cause a return of the psychosis.
The social worker also may be utilized in obtain-
ing additional information from the friends and
relatives of patients necessary for arriving at a
proper diagnosis. In other words, the state hos-
pital must be the center of advice for mental
health, an active rather than a passive agency
for good. Without such facilities for the further-
ing of mental hygiene, a state hospital for the in-
sane cannot be considered fully equipped for ade-
quate service to the public.
It is neither practicable nor essential to elab-
orate further as to the business methods or other
details of administration. These must be left to
the executive officer, whose training and experi-
ence should be such as to qualify him to solve such
problems. And, finally, it must be realized that
while present-day methods are undoubtedly the
result of progress, the ultimate stage has not yet
been reached. Radical changes in methods will
be met with from time to time, it being only nec-
essary to exercise judgment in adopting the same.
OCCUPATIONAL TREATMENT IN NERVOUS DISORDERS
Experience of a Lay Instructor— Forms of Occupation Best Adapted to Nervous Patients
and Those With Mental Disorders— Newfoundland Hooked Mats
By JESSIE LUTHER, Occupational Instructor, Butler Hospital, Providence, R. I.
THE therapeutic value of occupation as a means
of help and cure in nervous disorders is now
so well known, and so much has been written of its
theory and practice that extended comment on the
subject may be supei-fluous. The practical expe-
rience, however, of one who has been engaged in
such work from the early days of its general in-
troduction may be of interest to those who have
had similar experiences or are at the threshold of
work along those lines, even though this expe-
rience is presented from a lay point of view, with
no claim to consider the scientific aspect.
Today there are few institutions for the cure
of nervous or mental cases, hospitals or sana-
toriums, public or private, that lack an occupa-
tional department in some form. The idea, as
many already know, is not of recent origin, for as
early as 1843 such treatment was mentioned and
practiced by the first superintendent of the Utica
State Hospital, where a flourishing workshop has
existed since the eighties, other hospitals and
asylums having since adopted that form of treat-
ment in certain cases. This treatment, however.
was for the most part employed with the really
insane and almost exclusively for men, the occu-
pation being brush- and broom-making and gar-
dening. The general establishment of such treat-
ment, however, as applied to women as well as
men and in all phases and degrees of nervous as
well as mental disorders, is comparatively recent.
My own experience began fourteen years ago
when, in connection with Dr. Hall of Marblehead,
a small sanatorium was established off'ering work
instead of rest as a means of prevention and cure
of such maladies. At the old "Ark" in Jaffery, Dr.
Hall and I met as convalescents from illness, and
during our long hours of leisure the subject was
discussed and the project of such a sanatorium
with its attendant details of suitable occupation
became concrete and more than a theoretical pos-
sibility for the indefinite future.
As I had shortly before that time returned from
Hull House and the superintendence of the Labor
Museum with its weaving, spinning, and classes
in pottery, basketry, wood-carving, etc., it was
natural that such occupations, which were appar-
12
THE MODERN HOSPITAL
ently of interest to everyone and with the proc-
esses of which I was so familiar, should seem to
me to be most fitting for our experiment, and it
was decided to introduce the work along those
lines.
The question of suitable housing was a problem,
for facilities for working out of doors seemed im-
portant and houses in Marblehead with that pos-
sibility were scarce. It was May before we were
finally established in an ideal location on the rocks
at the entrance of the harbor, where wide piazzas
almost overhanging the waves made open-air
work not only possible but delightful.
This effort was tentative and at first more or
less experimental. The sanatorium was planned,
not for patients mentally unsound or for the more
Fig. 1. Specii
of early work done at the Handcraft Shop.
extreme cases of neurasthenia, but for those who
were on the verge of nervous collapse in need of
some special interest to check its progress or who
had passed through more extreme phases of the
malady and, in a state of convalescence which is
sometimes almost as uncomfortable as the disease
itself, were in need of some stimulus to take them
out of the inertia and self-consideration so char-
acteristic of that stage and so liable to become
chronic.
Realizing how persons in a sensitive state of
mind are influenced by their surroundings and
general atmosphere, it occurred to me that if they
could be introduced at once into a workroom
where beautiful and interesting things were being
produced as a regular routine by normal people
who would create a cheerful atmosphere, it would
act as an incentive to their own efforts and tend
to make them forget their real or fancied worries
and their invalid state.
To this end four normal, cheerful young girls
of the town were engaged and taught weaving and
pottery. They were present daily during working
hours, and, besides actually producing, assisted
the patients as they worked with them. These
girls were paid regular wages, and their products,
such as woven rugs, table covers, bedspreads, etc.,
were sold to help defray running expenses.
The work produced by the patients was in most
cases excellent, and the pride in accomplishment
and interest with its attendant benefit practically
universal. Although, as I have stated, the sana-
torium was started as more or less of an experi-
ment, the results before the end of the first year
warranted such extension as a small house in the
neighborhood for a dormitory, a plot of land for
gardening, and a small out-of-door workshop
where wood-carving and the noisier forms of oc-
cupation could be carried on. A large pottery kiln
in a building of its own was also substituted for
the small kiln in the cellar of the main house. On
Fig. 2. Hooked mat made by a patient at Butler Hospital.
every day of possible weather the piazza was filled
with pottery- and basket-makers, while the thud-
thud of the looms could be heard from the lower
workrooms.
Many visitors came to inspect, among them
numerous physicians from Boston and other cities
much more remote, for general adaptation of oc-
cupational treatment was then a novelty.
From this modest experimental sanatorium
known as the "Handcraft Shop" has been devel-
oped the well-known Devereux Mansion near Mar-
blehead, the change of location and its accompany-
ing expansion having been made a few years ago.
When the "Handcraft Shop" became fully es-
tablished I took advantage of an opportunity to
enter what seemed to me a more extended field for
work along the same line, at Butler Hospital in
Providence, R. I. Here the patients are not con-
fined to the mildly neurasthenic or convalescent,
but are often cases of actual dementia, some of
them of a discouraging type.
During the twelve years of my connection with
the hospital the personnel of the patients under
my charge has been as changeable as a kaleido-
scope, and the number occupied has increased
THE MODERN HOSPITAL
13
from eight in the original class to the present
number of between forty and fifty. Only one
patient has been with me from the beginning, a
dear old lady of whom I am very fond. The only
other patient of long standing joined the class in
my second year. On entering the hospital she was
supposed to have but a limited time to live. Her
class membership was an experiment. She was
the wife of a race-course book-maker, and her fa-
miliarity with her husband's calling influenced
her choice of songs ; sometimes when exhilarated
her indulgence in race-course music and encour-
aging cries to imaginary riders made her connec-
tion with a class a problem. Time and patience
were necessary to teach her to make a rafiia bas-
ket, the only form of work she would attempt,
but, the stitch once mastered, she has produced
many baskets, all practically alike in size and
shape. The choice of colors is her own, and most
of her work resembles the proverbial "Joseph's
coat." She works continually, and, although at
times she remonstrates in strong language with
an imaginary enemy, only a word is necessary to
bring her back to her surroundings and only once
in all these years have I been obliged to send her
from the class. Her interest in her work is never-
failing and her general mental and physical con-
dition far better than on entering the hospital.
Although a great many interesting cases and
cures have come under my notice, perhaps one of
the most remarkable was that of a woman who for
three years could scarcely be persuaded to make
the least effort and whose interest in basket-mak-
ing when finally aroused effected a veritable trans-
formation beyond the hope of the most sanguine.
In her case her improvement also had its bearing
on the other patients in the ward, for her work
was really beautiful and original, and her cheery
enthusiasm and unlooked-for energy awakened
the interest of many new patients in her constant
association with them and was of much assist-
ance in carrying on the special branch of work
during the interval between class hours. The
work was a joy to her, and even before her de-
parture from the hospital became a source of
needed revenue.
During the early days at the hospital my sym-
pathies were so keenly aroused that the class work
proved very exhausting. After twelve years' ex-
perience my sympathies are no less keen, but I can
consider a patient as one to be helped and, in a
difficult case, a stimulus to find a means of help-
fulness.
Occasionally I have been asked by those espe-
cially interested in occupational treatment if any
rules could be given as guides in teaching. I can
think of no rules except the obvious ones of un-
limited patience and unvarying cheerfulness — I
might add tactfulness and vigilance, but those are-
also self-evident.
It has seemed an excellent policy to ignore as
much as possible the fact that these people are
patients and take for granted that they are inter-
ested in the things of ordinary life. Many are
keenly alive to what is going on in the world, and
there are few who fail to become interested in
some degree in what is told them of people and
events, but the personal element, of course, enters
and it is necessary to choose one's subjects with
care.
Whenever possible the patients are urged to
use initiative — in the character of occupation it-
self, in designs if possible, and in choice of colors
employed. In regard to the latter it is interesting
to notice the colors chosen, pink, green, or blue
being the average first choice. Yellow and orange
are not so generally popular, in some cases act-
ually disliked, and there is often a strong objec-
tion to purple and black, though light violet and
pale yellow find more favor.
As regards the form of occupation, I have men-
tioned basketry in particular. Raffia basketry is
very simple, and I often use it as a test in the case
of new patients. If sufficient concentration is
shown, a choice is given of other kinds of occu-
pation as well, weaving, hooked mats, pottery,
stenciling, etc., all of which have been successful
with the class of patients brought to Butler Hos-
pital. Other forms of basketry, of reeds or pine
needles, are also offered, but raffia work requires
the least effort for a beginner.
The occupational department occupies the en-
tire upper floor of the Goddard House, once the
nurses' dormitory before the addition of the
nurses' home to the hospital. There is a large
cheerful central room for convalescents, the privi-
lege of occupying it sometimes being offered as a
reward of merit to patients who are inclined to be
noisy, in the effort to stimulate their self-control,
for no disturbance is allowed in that room and
there are many smaller rooms which make segre-
gation possible for those in a less normal condi-
tion. There are looms of various kinds, and rugs
and pattern-weaving made on them are really
lovely. Stenciling with crayons made for the pur-
pose has been popular from time to time. The
method is simple and within the power of anyone
not especially disturbed.
Pottery has in some cases proved of great help.
There is something very quieting in the use of the
plastic clay. One can see at once that mistakes
are not irrevocable, and patients who doubt their
po'.ver of accomplishment are content to give it a
trial. It is also valuable in offering an oppor-
14
THE MODERN HOSPITAL
tunity for self-expression which is sometimes a
relief or source of amusement to a disturbed mind.
A number of old-fashioned braided mats have
been made, and this work, as well as rug-weaving,
has the advantage of employing more than one
group of patients. Only a few can successfully
weave the rugs or properly sew the braided mate-
rial into form, but many can prepare the material.
Even disturbed patients tear it in strips ; in fact
this form of work appeals to some of them par-
ticularly; others sew the strips together and roll
them in balls ready for use, while still others braid
them.
I have found that colors are often a stimulus
in engaging a patient's interest, and soft wool of
lovely shades has proved an incentive to many
to knit scarves or small shawls, offering occupa-
tion for the idle moments of the day outside class
hours when other forms of work are generally
employed. With this stimulus of color in mind I
have for the past two years planned a May-day
party for which the patients make May baskets of
colored paper. They have been a great success
and an excuse for an annual tea party.
Perhaps one of the most interesting forms of
employment is the hooked mat, also a revival
along with the braided rug of colonial days. This
kind of rug is found in the rural districts of north-
ern New England, but especially in Nova Scotia,
New Brunswick, and the northern provinces.
My first acquaintance with them was in New-
foundland. Until the past two years my summers,
since my connection with Butler Hospital, and
two winters as well, have been spent in Newfound-
land and Labrador in connection with the Gren-
fell Mission, where as superintendent of the indus-
trial department I have established weaving and
other industries at St. Anthony and small villages
on the Newfoundland and Labrador coast. In
connection with this work I found the hooked
mats which in that country were purely utili-
tarian, being the only covering for the floors of
the average native house outside the city of St.
John's and the few real towns. These rugs are
used for warmth as well as decoration and are
made from any rags available — the remains of old
clothing and bits of remnants sold by the local
trader. The workmanship is often beautiful, but
the coloring and design very ugly. The rugs were
often brought to me and to other members of the
mission staff for sale, but for the most part their
purchase was only a charity and no outside mar-
ket for them would be possible except as curiosi-
ties and examples of native work.
One summer about nine years ago it occurred
to me that if this excellent workmanship could be
turned to account by providing attractive, simple
designs of a local character, subjects with which
the workers were familiar, and substituting color-
ing that would harmonize with ordinary house-
hold furnishings for the crude, nondescript color-
ing of the native mat, a market could be found out-
side Newfoundland for the product and the mak-
ers paid for their work outright with no respon-
sibility as to material or choice of coloring. The
designs which I made myself were local in char-
acter, reindeer, seal, walrus, ducks, komatik, and
dogs, etc., treated conventionally as a border, the
material of as fast colors as possible and for the
most part home dyed. These rugs could be made
at home during the long winter and particularly
what is known locally as "the matting season" of
late winter and early spring.
Every fall on my return from the north I
brought with me a shipment of products from
the industrial department for an annual sale in
Providence, Boston, or New York, and these
hooked mats were so popular and so many orders
received for them that since being unable to go
north during the past two years and having re-
signed from the mission, I have given out mats
with the same designs here at home, not only to
patients of the hospital but to many of the needy
Italians and others in this city in need of work
that may be done at home to eke out the family
earnings. Some of the workmanship has been
as satisfactory as that of the north, and among
the best is the work of one of the patients, a cut of
whose latest finished product is added to this arti-
cle, while she is fast completing another of a dif-
ferent design.
Although much of the product of the class room,
such as woven rugs, table covers, pillow covers,
baskets and plain sewing, are for the use of the
hospital, a large number of articles are for the
annual sale, woi'k with a special object usually
acting as an incentive and stimulating enthusi-
asm in the workers' efforts. The proceeds from
these sales have been for the benefit of the Visit-
ing Nurses' Association, the Red Cross, and the
British Relief. Since early summer we have
joined the great army of those who are striving
to "do their bit" in this great emergency by knit-
ting for the Red Cross and the Navy League. To
work for the soldiers is the greatest incentive,
and some of the patients are rarely without a
piece of gray or khaki knitting in their hands.
One woman alone has knitted fifteen sweaters, and
we have been able to send well over a hundred to
the Red Cross and a lesser number to the Navy
League, besides many mufl^lers and wristlets, and
several patients are now making helmets. Only a
few socks have been made, and as a rule by those
THE MODERN HOSPITAL
15
who were already familiar with the process before
entering the hospital, the intricacies of the knitted
heel in most cases requiring too much mental ef-
fort. A number of patients are incapable of any
work more difficult than plain sewing, and for
those the Red Cross has provided articles needed
for hospital comforts, so all are able to do their
part.
The grounds of Butler Hospital are large and
very beautiful, and as soon as the warm, spring
days permit, the class is taken to the lawn where
it is possible to continue all kinds of work except
weaving during the fair days of summer.
To know that the occupational form of treat-
ment has been found entirely successful, one need
only be sufficiently interested to follow the reports
of institutions having already given it a trial.
For my own part there has been the experience
of knowing many whom I first saw hysterical, un-
naturally passive or without self-control, with ex-
cited or dull, expressionless faces, sooner or later
arrive at a day when as normal, self-controlled
persons they have returned to their own environ-
ment It is true there are those who have been
unable to endure the contact with everyday life
and have returned for another period of help, but
others are happy with the members of their fam-
ily around them or in the midst of normal, absorb-
ing work in the business world and with expres-
sions of content on their faces that at one time
seemed impossible one could ever see there. If
pessimism ever existed in regard to this treatment
a realization of cases such as these would con-
vince the most skeptical that it is worth while.
HOSPITAL HOUSEKEEPING, ITS WORRIES AND CARES*
Sewing Room, Laundry, and Cleaning Service — Care of Walls — Wa^es of Various Classes
of Employes — Saving Due to the Fact That Employes Are Not Fed in Hospital
By MARY A. JAMIESON, R.N., Superintendent, Grant Hospital, Columbus, Ohio.
WHEN I was requested to read a short paper
on housekeeping, it rather struck my sense
of humor, for of all the various branches of work
in the hospital, this is the one that is most dis-
tasteful to me.
Each hospital, I find, is a law unto itself along
this line. Some think that a good housecleaning
once a year is all that is necessary for every pur-
pose, and I have about decided that, in many
instances, the cleaning at the present time must
be governed by the income of the institution, for
without a good income no hospital can, at the
price of supplies today and the high cost of labor,
keep up its housekeeping as it might wish. But
I have decided just to give you some idea as to
how we have our work done, also the cost.
We have a first-class housekeeper, whose work
is simply to look after the housekeeping. By this
I mean the keeping of the hospital clean, looking
after the linen when it is returned from the laun-
dry, taking charge of the sewing room, which
includes the making and mending of supplies, also
the employing of all the help used in this depart-
ment, as I always think it best for the head of
each department to both employ and dismiss all
employees in that department.
The sewing room comes first on the list, as here
the housekeeper makes her headquarters, having
a telephone that is connected with every floor, as
well as outside, and here all calls come for the
•Read before the Fourth Annual Convention of the Ohio Hospital
Association, Columbus, Ohio, May 28-30, 1918.
housekeeper. The sewing room has three motor
machines and is the adjoining room to the laun-
dry; here every morning all torn or worn linen
is carried and the first thing done in the sewing
department is the repairing of this linen; after
that the new articles are made up. These include
the aprons worn by the student nurses, but not
the dresses, which are sent out. The three women
are paid $8.32 a week; they room outside, but
have their meals at the hospital. The hours are
from 8 a. m. to 5 p. m. with one hour for lunch ;
no work on Sunday; a half day off every other
week.
Since we are dealing with the housekeeper's
share of the laundry, it might be wise next to
mention our linen man, as he is called. This man
brings all the linen from the floors to the laundry
(owing to the plan of the building, we have to
carry all the linen from the floors to the laundry) .
He also takes back in the morning all the clean
linen to run the floors, and again in the evening
makes a trip to see that there is plenty of linen for
the night nurses. This man also takes care of
the garbage cans, of which we have two for each
service room. In this way, after the can is
emptied, it is allowed to stand in the air for some
hours before being returned to the floor. Of
course, each time the cans are emptied they are
washed out with boiling water and made perfectly
clean. We pay this man $14 a week.
Now, for the cleaning, on each floor we have a
porter, a maid to look after the rooms, and a
16
THE MODERN HOSPITAL
maid in the serving kitchen. The porter (this
man is colored) works from 7 a. m. to 5 p. m.
with one hour for dinner; he goes out for his
meals. He is paid from $12 to $15 a week. He
cleans the hall floors, the service rooms, the serv-
ing kitchen floor, laboratory, bathrooms, all the
windows of occupied rooms, and the hall windows.
He also uses the vacuum cleaner on the rugs and
carries to the floor the chopped ice for the ice caps.
The maid on the floor is a white woman. She
starts to work at 7 a. m. and has one hour for
dinner (going out for this) and stops work at 3
p. m. One day out of every nine she remains on
duty to help sweep rooms emptied after 3 p. m.
and works half a day on Sunday. This woman
sweeps and washes all occupied rooms. She is
paid $8 a week.
Next is the maid in the serving kitchen. She
comes on duty at 8 a. m. and goes out at 10 a. m.,
has her dinner at home, and returns for work at
12:30, gets through about 2:30, returns to do up
the supper work at 5:15, and is generally done
about 6:30 p. m., making in all about six hours a
day. This maid washes the dishes, and is respon-
sible for the condition of the entire serving
kitchen aside from the refrigerator. She is paid
$7.50 a week. Sunday work is just the same as
any other day.
At our hospital when the patients go out we
wash the walls of all rooms if they have been
occupied for over a week. In this way the rooms
never get very dirty and they are not hard to
clean. Our routine is as follows :
When the patient leaves the room, the nurse
takes care of all the linen, sees that every part
of the work that belongs to the nursing depart-
ment is done, and then the head of the floor noti-
fies the office and the housekeeper that the room
is empty. The maid on the floor sweeps the room
and then the wall-washers (we keep six who
do no other work than washing the walls in the
hospital and the windows in the empty room),
take charge, wash the walls, and scrub the floors.
The wall-washers work nine hours a day and a
half day on Sunday. We pay them from $14 to
$16 a week.
Then the maids, of which we keep three for
this work, go into the room, wash the bed and
the furniture, do up the room just as any hotel
room is finished, and report the room to the office
and the housekeeper as ready. This may seem
like a great many people doing the same thing,
but it is not ; each person does her part, and after
months at this work, they are able in the shortest
period of time to report in a room as ready. No
person tries to do the other person's work; each
just does her own and gets out and is ready for
the next room. For instance, each of the little
maids knows her own work; one washes the bed
while another washes out the wardrobe, and the
dressing table; both then make the bed so as to
save walking around it. Meanwhile the third maid
changes the window sash curtains, puts on clean
stand covers, dusts the chairs, and goes out to
get the linen ready for the next room. In all it
takes about ten minutes after the room is turned
over to them.
If there are not rooms enough to keep the three
maids busy, they set the patients' trays, clean the
linen closets, and try to make themselves in gen-
eral very useful. They are paid $6 a week and
have their noon meal at the hospital, getting it
from the nurses' cafeteria, but eating downstairs.
These girls wear white and are always perfectly
clean ; they are girls from good homes. They
work half a day on Sunday (four hours). Right
here it might be wise to state that after three
years of just such washing, our walls look as well
as if they had just been painted this year, but
I have always been exceedingly careful about the
preparation that is used on the walls ; no experi-
menting is allowed. If any agent wants us to try
out his material, I get a sample and send it away
and have it tested to see if it will hurt the paint.
In this way we are often saved the need of paint-
ing, as many of the so-called cheap preparations
are good to take the dirt oflT, and equally good to
take off the paint. We use a preparation of lin-
seed oil soap; if we cannot get it we use other
vegetable oil soaps, allowing 40 pounds of soap
and 4 pounds carbo powder to 40 gallons of water.
To a bucket of water we add about 6 ounces of
the soap solution and wash with a soft cloth.
The walls are painted with a high-polish enamel,
and we find that it pays to use the very best, as
it is not alone the price of paint that costs, but
also the cost of putting it on. We have a perman-
ent painter, who keeps up the little repairs that
arise about a hospital. He is a union man and
is paid union wages. A permanent carpenter and
plumber are also kept, being paid union wages.
But to go on with the cleaning, a man is kept
busy from morning until night just washing steps.
Every step in the hospital is washed at least once
a day and those that are used quite frequently
are washed three times a day. I have never
known this step man to do any other work around
the hospital, but he does this one thing well, and
that means a whole lot. Just keeping the water
from going down the side of the step and in this
way marking the wall means so much to the house-
keeper. This man is paid $12 a week.
THE MODERN HOSPITAL
17
The woman in charge of the linen room is also
under the housekeeper. She, after getting the
house count, arranges the linen to be taken to the
floors, sorting as she goes along. This woman is
paid $8 a week.
Last comes the nurses' residence, this is also
under the housekeeper, but, as we have a good
woman in charge of the residence, it makes the
cares of the housekeeper, for that part of the
work, much lighter. This woman in charge of
the residence looks after the linen of the home,
and also takes charge of the man and the maid
who are kept there to do the work. She is paid
$35 a month and maintenance.
We feed no one at the hospital but the office
force, the women in charge of the nurses' resi-
dence, the three sewing women, the three little
maids, the nurses, and the nursing officers and
the house doctors. During the last year we have
found that it has paid us not to feed the help.
Owing to the high cost of food, the difficulty of
getting a variety, and the need of more help to
serve the seventy odd employees who used to eat
here, we find that we would have been out more
money than by paying the difference in the salary.
At first the help did object to the arrangement,
but in time they came around nicely.
I hear of other hospitals saying that they can-
not get nurses, and feel that our secret of success
along that line is partly due, no doubt, to the
fact that the nurses are not supposed to do maids'
work. They are taught how to clean, but they
are not at the hospital for a course of housekeep-
ing, so we do not expect them to do it.
I do not think it will be necessary for me to
say that the housekeeper is one of the busiest
women in the hospital. I was going to say her
hours were — but really think that she has no
hours, just keeps on until everything is done, if
such a thing is ever true about a hospital.
SELF-GOVERNMENT FOR THE RESIDENT MEDICAL STAFF
A Plan Introduced at New York City Hospital — Trend of the Time Toward Democracy
in Educational Institutions as Elsewhere — First Attempt to
Introduce Self-Government into the Hospital
By CHARLES B. BACON, M.D., Medical Superintendent, New York City Hospital, Department of Public Char-
ities, New York City.
THE medical service of the modern hospital is
not only a place for fitting young men re-
cently graduated from our medical colleges to
care properly for the sick; it is also an educa-
tional institution. At the termination of an in-
ternship these men go forth to engage in the
activities of life with a personal responsibility,
each one acting his part in the many medical,
social, and economic problems, each an honored
member of a noble profession. In order best to
meet these obligations young men need to have
placed upon them, during the years of prepara-
tion for life service, responsibilities associated
with their training and experience. Self-govern-
ment, as it appears to me, has a practical appli-
cation in its relation to young men ; I might say,
equally so to young women ; and I predict that a
modified form of self-government will in the near
future be introduced in many of our hospitals
and schools of nursing.
Self-government, as applied to student bodies,
has for many years been in successful operation
in many of our leading universities, colleges, and
schools. In certain educational institutions well
known to me, it is regarded by the faculty and
student body as practical and fundamentally cor-
rect, receiving mutual approval. Some months
ago, my interest having become quickened on this
subject, and a question arising affecting some-
what unusually the conduct and discipline of our
intern staff, I asked myself, "Why is not a modi-
fied plan of student self-government practical in
its application to the members of the intern
staff?" A large portion of our interns have an
academic, as well as a professional, degree.
Furthermore, their academic and professional
studies have been pursued in educational institu-
tions where self-government is already in oper-
ation.
FIRST INTRODUCED AT CITY HOSPITAL
So far as I know, this is the first effort to in-
troduce self-government as it relates to the intern
staff of hospitals. I decided that it might well
be initiated at this hospital. Accordingly, the
plan was experimentally placed in operation ap-
proximately one year ago. So acceptable and
satisfactory was this plan that it recently, at my
request, received the official approval of Commis-
sioner Wright.
I conceive it to be the duty of every adminis-
trative officer, whether he or she is charged with
the responsibility of directing the affairs of a
hofcpital or school of nursing, ever to keep in mind
that the status of the intern has changed, as well
18
THE MODERN HOSPITAL
as the spirit of the age, since we were interns.
Furthermore, the whole world is turning toward
democracy. I am quite familiar with what has
been said concerning interns during the past
twenty years, regarding their habits of conduct,
welfare, discipline, their relations to the various
officers of the hospital and school of nursing, the
attending staff, the patients, and the public. For
the greater part, nearly all one reads and hears
on this subject indicates that interns require close
supervision and have a veritable will to violate
established rules. I have long since concluded
that members of all professions dislike rules, and
rules established for disciplinary measures are,
to say the least, unwelcome.
To the medical administrative officer is given
an unusual and special privilege of relating him-
self most intimately with the members of the in-
tern staff. This relationship should be one of
advice and helpfulness, as well as corrective.
For twenty years my work has been thus inti-
mately associated with medical students and re-
cent graduates, not only as a medical administra-
tive officer, but also for seven years as instructor
and lecturer at the Long Island Medical College,
also beside teaching in the wards of the Kings
County Hospital. I appreciate that these men
soon realize that the practice of medicine is a
sacred art, a responsible calling, and requires the
best they can give. Thus their habits of life,
work, and play are measured by a scale of justice
to all members of the hospital organization, and
here let me say that an efficient organization and
fraternal cooperation are fundamental require-
ments.
No member of the hospital family comes in
such intimate touch with the intern as does the
superintendent. Our interns receive appoint-
ments following competitive examination, con-
ducted usually in February, and serve as junior,
senior, assistant house, and house officer, for a
period of two years. Prior to their entrance on
duty, they assemble in my office. This is my first
opportunity to speak with them as regards their
conduct, work, and welfare, as it relates to each
and to one another, and to the entire hospital
family. From this moment they are made to feel
that they are officers of the hospital and members
of our family, that each member bears a definite
relationship and position in our hospital organi-
zation. In this cordial, helpful, and mutual rela-
tionship it is possible for all to live and work.
Honor appeals to all. This has always been
impressed upon me from early boyhood days. I
expect that a modified form of self-government,
based on the honor system, will be the next for-
ward step in our professional administration,
particularly as it relates to the resident profes-
sional members, whether students, doctors, or
nurses. It may not be advisable to adopt this
plan in toto at once. Preparation must be made,
and the plan acceptable to all. Conferences with
the house staff and their cooperation are vital in
preparing the way and adopting the plan. This
is always necessary whenever a change is to be
made. We did not launch forth on this plan with-
out devoting ample time and consideration to it.
From the very beginning we received encourag-
ing support. At our final conference, when a
vote was taken, it was unanimously and enthusi-
astically approved, each and every member pledg-
ing his loyal support. Throughout the considera-
tion of this plan I was encouraged by the support
and cooperation accorded by Commissioner John
A. Kingsbury, First Deputy Commissioner Henry
C. Wright, and Mr. Lyman Beecher Stowe, secre-
tary of the department. Their helpfulness, to-
gether with the splendid spirit of cooperation
manifested by every member of the house staff in
this and other matters of mutual benefit, is grate-
fully acknowledged. The preparation of our plan
of self-government, its aim, constitution, and
resolutions, received long and careful study, and
will, I believe, serve as a guide and control in the
conduct, work, and welfare of our intern staff.
I am pleased to present to the readers of The
Modern Hospital our plan of self-government.
PLAN OF SELF-GOVERNMENT
Drafted by Dr. Charles B. Bacon, Medical Superintendent,
and the Members of the House Staff, New York City
Hospital, Department of Public Charities,
New York City
Thoroughly believing that a plan of self-government
based on the honor system, and already in satisfactory
operation in many of our leading universities, colleges,
and schools, is fundamentally correct, and pledging our-
selves to loyal obedience to such a plan, we enact and sub-
mit to the commissioner, Honorable John A. Kingsbury,
and deputy commissioner. Honorable Henry C. Wright,
the following aim, constitution, and resolutions governing
the resident medical staff of the City Hospital.
To observe those proprieties of conduct and courtesies
in our relations to one another, to all officials of the hos-
pital, the nurses, the patients, and the public, as shall
preserve at all times the dignity of the house staff and the
honorable standing of the hospital.
CONSTITUTION
Article 1. The name of this association shall be "The Resi-
dent Medical Staff Association for Self-Government."
Article 2. The purpose of this association shall be the gov-
ernment of the intern staff.
Article 3. The association shall be composed of active and
associate members. Active membership includes those
having received a regular appointment; associate mem-
THE MODERN HOSPITAL
19
bership includes those serving as special assistants, sub-
stitutes, and pathological interns.
Article J,- Active members only shall be qualified to hold
office in the association. However, associate as well as
active members shall be entitled to vote.
Article 5. The medical superintendent, together with the
chairman of the executive committee of the medical
board, and the assistant resident physician, shall be ex-
officio members. It shall be their duty to give counsel
and advice. They shall attend meetings on invitation,
also whenever matters of extraordinary or special im-
portance arise.
Article 6. Section 1. The association shall have power to
deal with all matters concerning the conduct and wel-
fare of the staflf members.
Section 2. The association shall have the power of in-
flicting penalties, to enforce its decision, even to the
extent of recommending the expulsion of a member to
the medical superintendent.
Article 7. The house statT shall hold meetings in the staff
room, Janeway Hall, at least once a month.
Article S Section 1. The executive power of the association
shall be vested in an executive committee of five members
— one member to be elected from and by each division
(house, assistant house, senior and junior) — and one
shall be elected at large by the entire house staff. The
medical superintendent, together with the chairman of
the executive committee of the medical board, shall be
members ex-officio.
Section 2. This committee shall elect a president, a vice-
president, secretary and treasurer.
1. The duties of the president shall be to call together
and preside over all meetings of the association and the
executive committee.
2. The duties of the vice-president shall be to assume
the duties of the president in his absence or at his re-
quest.
3. The duties of the secretary shall be to keep the min-
utes of the association and a list of the members, to post
notices of the meetings, and to attend to the correspond-
ence of the association.
4. The duties of the treasurer shall be to collect all
dues and assessments established by the house staff.
Disbursements of $5 or over shall be made only upon the
recommendation of the house staff. Disbursements un-
der $5 may be made upon the recommendation of the
executive committee.
The treasurer shall post on the bulletin board at Janeway
Hall the amount due from each member, also on the first
of every moi.th a complete financial report.
Section 3. 1. The officers of the executive committee shall
be semi-annually elected by ballot, by the association, on
the 15th day of June and the 15th day of December (or
on the following day, should this day fall on Sunday or
holiday) they shall enter upon their duties immediately.
2. The executive committee shall bring to the attention
of the house staff, assembled in session, any suggestion
which shall have been brought to the attention of the
committee by any member of the house staff, providing
this suggestion receives a majority vote in affirmation
at a meeting of the executive committee.
3. The executive committee shall take under considera-
tion all matters relating to the conduct and welfare of
the house staff.
4. The executive committee shall settle all differences
arising between members of the house staff. Appeal
from such decision may be made before the house staff
in session. Until such decision shall have been appealed
and acted upon by the house staff, the decision of the
executive committee shall remain in force.
5. Any member of the executive committee may be im-
peached by a majority vote, and removed from office by
a two-third vote of the assembled house staff. Election
to office, created by such vacancy, shall be by and from
the interested division, in the event of a divisional rep-
resented vacancy, and by the assembled house staff in
the event of a vacancy in the office of the representative
at large.
Article 9. Section 1. The legislative power of the asso-
ciation shall be exercised by the whole house staff. One-
third of the members shall constitute a quorum.
Section 2. A meeting of the association may be called at
any time by the president, and must be called by him on
the application of three members or the medical super-
intendent. Should the president be unable to call a
meeting, it shall be called by the vice-president.
Section 3. The rule of a majority shall prevail in all meet-
ings where a quorum of the association is present-
Article 10. Section 1. The judicial power of the associa-
tion shall be vested in (1) the association, sitting as a
judicial body — this body shall constitute the highest
court, wherein the rule of the majority, consisting of
two-thirds of the members of the association, shall pre-
vail— and (2) the executive power, constituting the
lower court, before which all matters must first be
brought, and from which an appeal may be made to
the whole association, sitting as a judicial body.
Section 2. In extraordinary cases, before a decision has
been reached, the association sitting as a judicial body,
at the request of the executive committee sitting as a
judicial body, and upon an affirmative vote of two-
thirds of the members of the association, may delegate
its supreme jurisdiction to a special court, consisting of
the executive committee, the medical superintendent,
and the chairman of the executive committee of the
medical board. The latter two members shall, if deemed
by them advisable, present the matter, for final and
official action, to the commissioner.
RESOLUTIONS
Relating to the Resident Medical Staff Plan of Self-
Government
1. Resolved, That the constitution and resolutions of the
association be semi-annually read aloud by the secre-
tary to the members of the association, once during the
month of June, again during the month of December.
2. Resolved, That two days previous to any meeting of
the association a notice of said meeting be posted on the
house staff bulletin board at Janeway Hall, and twenty-
four hours previous to the meeting a complete list of
subjects to be discussed be likewise posted. In cases
requiring immediate or private action this regulation
may be set aside by the president.
3. Resolved, That the executive committee, sitting as a
court, be empowered to require testimony from any
member of the association.
4. Resolved, That members of the house staff shall regis-
ter their name, date, time of departure, time returned,
together with name of substitute, in the house staff time
book to be found at the hospital, in the bureau of in-
formation.
5. Resolved, That we declare our intention and will to
strictly obey all rules heretofore promulgated, or that
may be promulgated by the commissioner, affecting the
conduct and welfare of the house staff.
20
THE MODERN HOSPITAL
6. Resolved, That each member of the house staff shall be
provided with a copy of the constitution and resolutions.
7. Resolved, That application for leave of absence shall
be submitted to the medical superintendent on the regu-
lar form for this purpose. This shall be permanently
filed.
8. Resolved, That no member of the house staff shall en-
tertain visitors without having first secured the consent
of the medical superintendent.
9. Resolved, That the executive committee shall exercise
supervision over the residence of the intern staff, the
rooms, hallways, bathroom, staffroom, and library. This
committee shall endeavor to see that the house rules
are carefully observed by all members, such as punctu-
ality to meals, visitors to the home, quiet, etc.
10. Resolved, That the house staff service schedule shall
be tentatively prepared by the assistant resident physi-
cian for the consideration and approval of the house
officers, not later than the evening of the twenty-fifth of
the month. When agreed upon, the schedule shall be
posted on the bulletin board at Janeway Hall, for the
attention of the association, and shall be delivered to
the medical superintendent for his approval, and typing,
not later than noon of the last day of the month.
AMENDMENTS
This constitution and these resolutions may be amended
or added to at any regular meeting of the association
assembled in session, by a two-third vote.
MEMORIAL HALL OF BUFFALO GENERAL HOSPITAL
Protection of Patients From Disturbing Noises One of the Foremost Thoughts in Plan-
ning— Every Comfort in Patients' Rooms — Harmonious Color Effects — Oper-
ating Room Isolated From Patients* Rooms
By EDWARD F. STEVENS, Architect, Boston.
DURING the past twenty-five years the Buffalo
General Hospital has made rapid growth and
noteworthy improvements. Its capacity has in-
creased from 125 to 375 beds. The plant has been
practically rebuilt. First, the east pavilion, a
beautiful structure of terra cotta and brick, con-
room ; and now, just completed, the new pavilion
for private patients, to be known as "Memorial
Hall."
In the designing of this Memorial Hall, the gen-
eral outline and type of architecture of the east pa-
vilion was duly considered and adopted. The plan
Fig. 1. Memorial Hall, the new private patients' pavilion of Buffalo General Hospital. Buffalo, N. Y. Edward F. Stevens, architect.
taining wards and rooms, an operating depart-
ment, and laboratories ; next, the children's build-
ing; then within a twelvemonth the new service
building, complete with up-to-date equipment and
conveniences for the staff, and a nurses' dining
was given much study by the superintendent and
the architect so as to come as near perfection as
possible for the housing of the sick.
The new building, caring for sixty-two patients,
is but a part of the entire pavilion, as the connect-
THE MODERN HOSPITAL
21
ing corridor, with its large day room and airing
balcony, owing to existing buildings, has not yet
been built; and until this has been finished, the
plan will be incomplete. The room portion of the
pavilion, however, is quite complete.
One of the foremost thoughts in mind was to
protect the patient from the usual disturbing
noises caused by elevators and trucks and the clat-
ter of dishes and equipment. To accomplish this,
the noisy portions of the unit — the elevators, the
Fig. 3. Typical bedroom floor plan of Memorial Hall. Note how quiet is insured by the placing of the noisy portions of the unit, such as ele-
vators, sink room, and serving kitchen, on separate and cross corridors, away from the approach to patients' rooms.
Fig. 4 Operating floor of Memorial Hall.
While most well-planned pavilions for the care sink room, the serving kitchen and the staircase —
of private patients are much alike in plan and are placed so as to open on separate and cross
equipment, in this building there are some fea- corridors, away from the approach to the pa-
tures which should be of interest and should repay tienf rooms. The partitions enclosing patients'
a careful study. rooms are deadened with an insulating quilt on
22
THE MODERN HOSPITAL
both sides of the metal studs, preventing the
sound from one room being transmitted to an-
other room. Floor noises are practically elimi-
nated by the use of cork tile for all corridor floors,
and linoleum for the floors in patients' rooms. All
utility rooms are vestibuled from the main cor-
ridor.
The patients' rooms are planned for every de-
gree of comfort. The base is gray terrazzo, the
floor of gray "Jaspe" linoleum, and the walls
tinted in warm, pearl gray. The color effect
is carried out even in the electric lighting fix-
tures.
Each room is provided with a special pattern
hygienic lavatory for washing under running
water, a closet, telephone connection, and wall
plugs for bedside lights and nurses' calls.
al Hall, showing type of bed,
nd general utilities.
There are general toilets and baths for the
nurses, the doctors, the patients, and the visitors.
Several suites of rooms have private baths.
The sink room on each floor is completely
equipped for all services to the patient not pro-
vided by the serving kitchen and the linen room.
The silent electric light system has been in-
stalled for the calling of nurses by the patient,
with a recording device showing the time elapsed
between the making and the answering of each
call. The signal is also given by a red light over
the door of the room and by an annunciator sig-
nal over the desk of the head nurse. The call can
be canceled only by the nurse going to the head
of the patient who sent the call and using a key
to reset or release the call.
The serving kitchen is equipped with all mod-
em conveniences for preparing and serving food
in the most delicate way. The sink rooms are pro-
vided with sterilizers for instruments and basins.
A medicine closet, with special plumbing, is placed
on each floor.
The operating department for the pavilion is
most complete, located, as it is, on the top floor,
away from the patients. There are three oper-
ating rooms, well lighted and supplied with
built-in cabinets for the storage of instruments
and supplies. There is a plaster room convenient
to but out of the operating area. The surgeon's
scrub-up is in the corridor, near the operating
rooms. The nurses have their work room, dress-
ing room, and toilet. The surgeons have their
locker room and toilet.
The usual sterilizers are provided in the steril-
izing room, except for the water boilers. The
water for all clinical purposes is distilled in the
Fig. 7. Operating room of Memorial Hall, showing direct-indirect radi-
ator behind glazed screen, built-in cabinets, and distilled water
reheater.
tower and piped to the various operating rooms,
where it is reheated by steam to the desired tem-
perature.
In the basement or ground floor will be found
the genito-urinary clinic and a small but complete
psychopathic department for the treatment of the
THE MODERN HOSPITAL
23
occasional delirium tremens patient, with a con-
tinuous bath. On this floor also will be found re-
tiring rooms for the special nurses.
The elevators are of the latest type, with special
hospital cars and all safety devices.
The group plan is such as to make available
large yards to the south. These will be developed
into lawns with groups of shrubbery, beautifying
the appearance of the institution from the street
as well as from the patients' window.
LITTLE JOURNEYS TO PLACES AND PEOPLE WORTH KNOWING
The Second Little Journey— To Grant Hospital. Chicago, an Efficient and Well-Managed
Institution in Which Sympathy and Understanding of the Individual Are Key-
notes— Some Factors in Its Success
By MARGARET J. ROBINSON, R.N., Field Editor of the Modern Hospital, Chicago.
ported, principally by Americans of German de-
scent, through annual memberships, bequests, and
GRANT HOSPITAL, Chicago, was organized
in 1883 for charitable purposes, primarily to
give care to the sick who could pay little or noth-
ing. It was then housed in a small building
erected as a residence. Since then the scope of
its work has been enlarged to include a hospital
legacies. It has an active woman's auxiliary,
which buys linens and needed equipment. The
present building was made possible by the gener-
osity of Catherina Seipp, who gave the necessary
Fig. 1. Grant Hospital. Chicago. View showing the garden.
of one hundred and fifty beds and an out-patient
department which gives high-grade service to pay
patients ; but over 30 percent of all cases treated
are free bed cases.
The hospital has a gradually growing endow-
ment, which gives it an income of a few thousand
a year. The institution is maintained and sup-
funds in memory of her husband and son. The
building was opened for patients February 16,
1913.
The building presents a dignified exterior of
solid construction, and is architectually attractive.
Alinough it is in the congested North Side dis-
trict of Chicago, the architects so planned it on
24
THE MODERN HOSPITAL
a triangle that enough ground space was left at
the rear to have green lawn and shrubs and a
place for recreation and the baby tents.
The hospital, since its incorporation in 1883
until quite recently, was known as the German
Hospital of Chicago, but at present the bronze
name tablet which has ornamented the front of
the building is being melted down and is getting
ready for its new name. The rubber door-mat at
"I the light, roomy kitche
in Grant Hospital.
my visit still bore the legend "German Hospital,"
but I was told that this was to be changed by
adding a T to the "German" and taking out the
E and the M.
The day I visited the hospital, the assistant
secretary of the board, Mr. Dilg, who is an official
Liberty bond salesman, told me that the em-
ployees of the hospital had bought $5,900 worth
of bonds of this last issue. The service flag car-
ries thirty-two stars, twenty-si.x for the men in
the medical reserve and other branches of the
service, and six for the nurses over there.
Miss Lewis, the superintendent, was at lunch
when I came in, but she finally appeared, attended
on the right side by a nurse asking questions, in
front by two visitors who wanted to inquire for
a patient, on the left by an intern asking more
questions and in the rear by one of the girls in
the office, who was trying to get her to the tele-
phone, and both of her hands were busy knitting
on a khaki brown sweater.
When she found time and breath to speak to
me, I said, "When in the world do you get time
to knit sweaters?"
"Why not?" said Miss Lewis. "I knit a sweater
and a cap for every man who goes from here into
war service, and they all write to me and I write
to them."
"Do you ever sleep?" I asked her, and she said:
"Oh, yes, about six hours every night; that is
enough for anybody." I thought, however, that
it was not everybody that could do with the same
amount of sleep that was needed by Miss Lewis
and Thomas A. Edison.
Soon Miss Lewis and I started over the building,
beginning in the lower regions. Down in the
engineering department, where the powers that be
run the heating plant and laundry and things in
general, everything was greased and shiny and
busy, and the refrigerating plant thick with its
usual heavy frost.
The laundry was busily grinding out clean
sheets and towels and nurses' clothes, and the
giant mangle ironing things on both sides with
very little human help. Soiled cotton is washed
and tumbled here, and much of it is saved in that
way. In the sorting room the steel cupboards
were black on the inside, and the piles of accu-
rately folded linen stood out in strong contrast.
I should think that this would simplify the work
and give less eye-strain to the people who have
to work here all day.
The kitchens are big, roomy, light, and well
equipped with everything to make the work as
easy as possible for the workers. A man who
had lost one hand was mopping the floors, and
doing it well. Miss Lewis said that he was one
Fig. 3. Maternity ward in Grant Hospital. \v
cart de-siKned here for the transporta
baskets.
of her best house-men, a permanent employee.
In fact, she only wished she could get more like
him and another partial cripple, a man with only
one leg, who is also on the roll of permanent
employees.
There was a pleasant staff and nurses' dining
room. Miss Lewis says that restraint and dis-
cipline are all off in this room during meals, and
that the interns and nurses and office employees
may talk and laugh and relax their dignity while
they eat.
On the first floor in the rear, and having its
own separate entrance, are the out-patient depart-
THE MODERN HOSPITAL
25
ment, the pharmacy, and the radiographic and
pathological laboratories. A full-time salaried
pharmacist, a roentgenologist, a pathologist, and
an assistant are employed; also a social sei'vice
worker. There is plenty of equipment to do any
diagnostic work needed.
The hospital is provided with a Pfaudler glass
enameled linen chute, which can be water-flushed
and cleaned ; a light call system for patients ; and
the still small voice which announces in the cor-
Fig. 4. Nureery i:
dressing table
this table.
ridors and the operating rooms that "Dr. Jones
is wanted at the telephone, please."
The floors everywhere are covered with battle-
ship linoleum. The private rooms are attractive
and well furnished and made homelike by the
curtains of sunfast wash material, rose-colored
in the rooms on the north side, blue in those on
the south. There are no shades on the windows,
and ventilation is secured by the inlets from the
curtained French windows and the oulets of the
curtained transoms above them.
In the obstetrical department, which is a most
busy and interesting place and a department
which has been a particular success in this hos-
pital, there are two delivery rooms. There had
been sixty-six arrivals in the month of March, I
was told. I asked what happened when three
new citizens took it into their heads to come to
town all on the same evening, and Miss Lewis
said, "Oh, we manage all right; if the delivery
rooms are both busy, and a third case comes in, we
have a big wide cart we can use, and everything
else is right handy up here." Sixty-six babies in
one month in an hundred-and-fifty-bed hospital
certainly shows the confidence of the doctors and
the public in that obstetrical department.
In the hall we passed the sectional cart designed
here and used by the young ladies and gentlemen
in this department to motor to their lunch.
The nursery, of course, was the most interesting
place in the whole hospital. On the shelves around
the I'oom, in the wire sandwich baskets, were
forty-two new live babies. They were all quiet
and contented except two. These two were not
sick, and didn't have any especial reason for cry-
ing, they just wanted someone to notice them.
There were two "teenie weenies" in the incu-
bator. Both were doing well, and one of them
was making a brave attempt to make himself
heard. This one was a premature of only six and
a half months, but the nurses seem to think that
he is going to "make it" and grow up like other
folks.
The table on which the babies are cared for was
designed and made especially for this room. It
is 36 inches wide and 36 inches high. It is built
something like a large flat-top desk, of white
enamel finish and is long enough to hold half a
dozen babies at one time. It has drawers on both
sides in back and front. These contain everything
in the way of clothes and toilet accessories that
the babies need. The table has an endowment
of its own, and bears the name-plate of the donor
on the side of it.
In a small adjoining room there are warmed
nickel plates where the babies are washed and
get their shower baths. Of course, the patients
Fig. 5. The roof-garden of Grant Ho.-spital, with its latticed pergola.
in this department are all thoroughly labeled so
that they won't get mixed.
The operating suite was another busy place, and
a force of nurses and orderlies were cleaning up
after a long morning's work. This department
has everything about it to indicate good work
and plenty of it to do.
The roof garden is delightful. It has a pergola
with latticed sides all ai'ound it, and tiled flooring.
Several patients in wheel chairs were up here
sunning themselves, and over in a corner was a
three-months-old orphan baby in a carriage. You
26
THE MODERN HOSPITAL
know how hospital people love these orphaned
babies and make much of them. This baby cooed
and laughed and stuck out her tongue at us in
most friendly fashion. Miss Lewis said that one
of the interns had made her his especial charge
and wheeled her out for an airing every day.
Looking over the report of the superintendent,
read before the Woman's Auxiliary in 1915, I
found so many good things that I am going to
take some of them and give them to you in this
article just as they are.
"A patient now keeps his identity. It means
that every patient has individual attention, from
the doctor down to the humblest servant in the
house; that an interest is taken in his mental
and physical welfare. In just so far as this inter-
est increases, and sympathetic attention given
promptly and cheerfully, will the name 'hospital'
come to mean a place of comfort given and not a
place of fear."
Miss Lewis, in the same report, gives credit to
each of her assistants who has helped to make the
hospital a success. She refers to Miss B — , the
dietitian, as a very efficient little woman, and tells
of the well-prepared and well-cooked food. Else-
where she mentions the splendid work in the oper-
ating rooms and gives the credit to the supervisors
there. She says that her day and night super-
visors are towers of strength and energy. This
sounds like team-work, and you feel it in the atmo-
sphere when you are in the hospital.
The eight-hour day has been worked out suc-
cessfully here, and is one of the things that has
helped to produce the team-work and the cheer-
fulness. This system is surely an answer to a
lot of problems. When it comes into all the hos-
pitals to stay, sore feet and aching backs, some
of the apparent stupidity in class work, sick nurses
and cranky nurses will all pass. The temper of
hospital workers will then begin to be what it
ought to be, and administrators and doctors who
are willing to work a gentle woman of delicate
nervous organism twice the length of time each
day that a street contractor would dare to work
a husky laborer, will pass along too.
Miss Lewis, in an article in the Department of
Nursing in the January number of this magazine,
tells of the plan for the eight-hour system and
the advantages it has brought into their work.
She is now working out a definite time-saving plan
for the systematizing of the work of the night
supervisors of which she will tell later.
The efficiency of the nursing service is due, not
alone to the excellent system in force, but also
to the helpful, kindly, human spirit that inspires
the system. No one in Grant Hospital is a mere
cog in the machine; the human element is never
lost sight of. "I have broken down every barrier
between my nurses and myself; I want them to
come to me with their troubles and problems as
freely as they would to their own mothers," says
Miss Lewis. She believes in preventing the com-
plications which sometimes arise in institutions
where young men and women meet in their daily
work, not by unnatural repression — by forbidding
conversation and social relations — but by recog-
nizing the just claim of these young people to
acquaintanceship and social relations under proper
conditions. Miss Lewis herself introduces her
interns to her nurses; she permits the latter, in
their evenings off duty, to accept from these
young men invitations sanctioned by her, pro-
vided reasonable hours are kept. This has not
increased the social demands made on the nui'ses
— rather the contrary — so much sweeter is for-
bidden fruit! Incidentally, Grant Hospital never
has any trouble about getting interns.
Miss Lewis believes that the comparatively
mature and experienced woman often makes a
better nurse than the young high-school graduate.
In fact, she prefers, as candidates for her training
school, women who have had experience in other
lines of work, such as teaching or business, even
though some of these may not have had a high-
school education.
Each hospital has some one significant thing
about it, and you carry memories of each labeled
and indexed by that significant feature. You re-
member one for its fine social service, another for
its beautiful scenic surroundings, another for its
cleanliness and order, another for its scientific
research work, another for its community spirit
and so on.
I think my memory of the Grant Hospital will
go down something like this: This hospital is
efficient, but in getting efficiency it has not sacri-
ficed the individual. There is a human and per-
sonal atmosphere about the place. Staff and
office, nurses and interns and employees, all seem
to have an interest and a share in the work ac-
complished. The success of Grant Hospital seems
to me to be due to several things: the intelligent
administration, of course ; the financial support of
its benefactors; its adequate building and equip-
ment, and to the forceful personality and kindly
spirit of its executive head. In a word, it is a
non-institutional hospital.
It was a wise old southern deacon who advised with a
chuckle: Keep yo' tempah, son. Doan yo' quarrel with nc
angry pusson. A soft answah's alus best. Hit's com-
manded, an' furdermo'. hit makes 'em maddah'n anything
else yo' could say.
THE MODERN HOSPITAL
27
FROM THE FIELD EDITORS' NOTE BOOKS
Presbyterian Hospital, St. Luke's Hospital, Grant Hospital, West Suburban Hospital,
Evangelical Deaconess' Hospital, Harper Hospital, Agatha Hospital, Sacred
Heart Hospital, Youngstovvn Hospital, and Iroquois Memorial Hospital
Perhaps the most distinctive features of St. Luke's are
Presbyterian Hospital, Chicago
This hospital has taken care of its ward patients with-
out raising rates, although the cost to the hospital of each
ward patient is more than seventy-five cents a day in
excess of what the patient pays for his care.
When the government requested all hospitals to in-
crease the number of nurses in training up to the limit
of capacity, the Presbyterian Hospital went further than
this. It fitted up two houses on the same street and re-
moved all the women employees except nurses out of the
Sprague Home for Nurses. It then took in probationers
to fill every available space left vacant. This move is
costing the hospital eight thousand dollars a year.
Unit 13, headed by Dr. Dean Lewis, was largely re-
cruited from this hospital, and with it have gone into
service 6 attending physicians, 8 associate physicians, 12
assistant physicians, 15 interns, 2.5 nurses, 3 orderlies.
Gauze sterilizer used for general sterilization in Presbyterian Hospital,
Chicago.
and 9 other employees. Since then the number of those
in service has been added to until now the service flag
carries under its one big star the number 126.
In the annual report, when one reads down the pages of
the medical board, the executive staff, the house staff and
the school for nurses, many names are preceded by a little
black asterisk and others by a small black dagger. The
foot note below reads "*In government service." "tin
Red Cross service in France."
The annual report also contains the following: "Re-
sponding to the request of the government for conserva-
tion of food, we at once inaugurated a system of serving
which has reduced the amount of food used fully 25 per-
cent. This has been done with the cooperation of both
patients and employees."
The Presbyterian Hospital is not only doing its bit, but
doing its best.
St. Luke's Hospital, Chicago
St. Luke's Hospital, Chicago, has been established for
fifty-one years and ranks among the best-known of the
high-standard institutions. The bed capacity of the hos-
pital is about four hundred. From seven to eight thou-
sand patients are treated each year. The departments in-
clude medical, gynecologic, ophthalmologic, otologic, oral-
surgical, dermatological, surgical, obstetric, rhinologic,
laryngologic, orthopedic, and neurologic.
the high-grade private-room service, the children's depart-
ment, which is doing especially fine work in orthopedics,
and the training school for nurses.
The training school admits only young women who have
a definite academic educational foundation for nursing edu-
cation. This nursing education is given thoroughly and
with every means for instruction and equipment. The
health and comfort of the nurses and their recreation are
carefully provided for. The nurses in the school have the
advantage of gymnasium and tennis courts and the privi-
lege of one of Chicago's exclusive bathing beaches.
Classes in French are given for those who wish to attend
them. Only nurses of the best grade are sent into the
nursing field as graduates of St. Luke's.
The hospital, believing it to be a duty to comply with
the request of the government to increase the number of
nurses in the school, has added twenty-five to the usual
number in training. This was made possible by renting
two flats in the neighborhood and by the generosity of
Mr. and Mrs. W. G. Hibbard of Chicago, who turned over
their residence to the hospital for use in housing the extra
nurses.
The visitors' dining room in the hospital is an especial
feature at St. Luke's. It is not a small room, casually
furnished for this purpose, but a large well-furnished
dining room in constant use by relatives and friends of
private patients and staff.
In the children's department there is a special ward
for tonsil and adenoid cases, an entrance observation
ward, wards for medical, surgical, and orthepedic cases.
There is a kindergarten, and a teacher comes every morn-
ing to instruct the children who can come to the classroom.
There are plenty of small wheeled chairs for the small
folks, and in the children's department every meal for
the children who are up and about becomes a tea party.
Many a child who would otherwise have little appetite
enjoys his dinner when served to him while he sits in a
little red kindergarten chair at a low table and with all
the other children around it, making a playtime of the
meal hour.
The orthopedic department does the follow-up work of
the infantile paralysis cases of Cook County Hospital, and
the hospital is planning to do the reconstruction work for
its disabled patients.
West Suburban Hospital, Oak Park, III.
The West Suburban Hospital in Oak Park is a success-
ful open-door hospital of 125 beds owned by a body of
physicians and surgeons of that suburb. The hospital has
surgical, medical and obstetrical service. It takes cai-e of
forty-five obstetrical cases a month on an average. Be-
sides the regular officers of the hospital and the training
school, the hospital employs four interns, a pharmacist,
a dietitian, and technicians in the pathological and radio-
graphic laboratories.
Mr. Joseph Purvis, the superintendent, believes in
women interns for general hospitals. One of the four
interns now employed is a woman, and more will be added
as needed. The management makes special effort to
receive patients and visitors intelligently and cordially,
and no discourtesy is tolerated from any employee.
28
THE MODERN HOSPITAL
Fig. 1. Grant H
In the obstetrical department, opposite the maternity
room, is a special room for waiting' cases. The patients
are brought to this room after the first symptoms of be-
ginning labor, and before it is necessary to bring them to
the maternity room. The patient is not returned to her
ward or room until she is in good condition, and the other
patients in this department are spared the sound and
knowledge of the progress of a case in labor.
pital, Columbia, Ohio.
features of many private hospitals, where the service to
the patient and the education of interns and nurses are
sacrificed to the making of dividends, are absent in this
hospital. The building is always full to capacity, and the
proof of public confidence lies in the fact that the hos-
pital has not enough beds to meet the demand for them.
The roof garden, shown in the illustration, is one of the
most popular places in the hospital, and patients are
Fig. 2. The roof garden. Grant Hospital, Columbus, Ohio. K
Grant Hospital, Columbus, Ohio
Grant Hospital, Columbus, Ohio, a private hospital,
owned and controlled by Dr. J. F. Baldwin, has 529 beds,
a high-grade training school, and all the usual atmosphere
of a general hospital. The greater part of its service is
given in moderate-priced private rooms. The objectionable
;re are cool breezes and a wonderfuJ birdseye view of the city.
anxious to rest here whenever their condition and the
weather allows. A more detailed account of the work of
Grant Hospital will be given later in these pages. A
paper on "Hospital Housekeeping," by Miss Mary A.
Jamison, superintendent of Grant Hospital, appears in
this issue.
THE MODERN HOSPITAL
29
Evangelical Deaconess Hospital, Marshalltown, Iowa
In the Evangelical Deaconess Hospital in Marshalltown,
one sees a well-ordered and cleanly institution which is
progressing rapidly and has shown its success by meeting
its growing needs. The original building has been recon-
structed to add modern hospital facilities and in the near
future the hospital expects to add laboratories which will
Evangelical D'
Home and Hospital, Marshalltown, Iowa
give to its patients every advantage of scientific diagnosis.
The new wing of private rooms has everything to make
it attractive. The rooms all open on a sun corridor which
is surrounded by thoroughly screened French windows.
The whole corridor is a sun parlor for convalescent
patients.
The Rev. Karl Rest, the superintendent, and Sister
Sophie Hublie, the superintendent of nurses, deserve much
credit for the advance the hospital is making.
Harper Hospital, Detroit, Mich.
Harper Hospital is surely doing its share. It has sent
overseas to France its own base hospital unit, even at the
expense of making a shortage everywhere in the organi-
zation, in the visiting staff, the house staff, and the train-
ing school. The house staff, which usually has thirty in-
terns, now has only seventeen. The hospital service flag
carries 119 stars on it.
The second floor of the Buhl Memorial Building, the
clinical dispensary building, has been given over entirely
to the use of the medical reserve, the aviation corps, and
the ordnance department, for physical examinations. Over
450 men have been examined here for the ordnance depart-
ment. Examinations are also made here for the regiment
of expert mechanicians and workmen being raised for the
government.
Special arrangements have been made for the quaran-
tine of venereal diseases under the new application of the
laws controlling communicable diseases in Michigan which
the state board of health has applied for the protection
of the men in cantonments. Follow-up work is done in
these cases and reports made to the state. The emer-
gency war fund of this state is helping to pay the ex-
pense of this work.
The chef at Harper has made his own particular recipe
for war bread, which the hospital will give to other hos-
pitals who may wish to know about it.
Agatha Hospital, Clinton, Iowa
The Agatha Hospital in Clinton, Iowa, is another hos-
pital which is an example of the good work which can be
done in small cities. The hospital has gained the support
of the public and will have to enlarge upon its present
quarters to accommodate the patients who wish to enter
it for treatment.
There is an excellent training school in charge of the
superintendent, Miss Tanner, who is a graduate of the
Michigan University Hospital at Ann Arbor, and her as-
sistants, who are graduates of the Michael Reese and
Wesley Hospitals, Chicago.
The hospital has well-equipped pathological and x-ray
laboratories, and unusually good surgical technic in its
operating and obstetrical departments. It is fortunate in
having on its staff of physicians and surgeons men who
use the most modern methods of diagnosis.
The nurses' home has a home atmosphere that is not
usual in institutions, and I was particularly impressed
with the type of nurses, a type that showed distinctly
their culture and refinement and an intense interest in the
work to be done. Clinton is certainly to be congratulated
in having such a standard hospital and such a thoroughly
capable woman to administer it.
Sacred Heart Hospital, Fort Madi.son, Iowa
The sister superior of this hospital designed herself
the chart racks which are used on the nurses' desks on
each corridor of the hospital. They are made of var-
nished wood, and on the inside are strips of zinc which
act as slides for each chart. On the outside, on the left
of each open space, is a small round brass number plate
for each room and ward and on the right of each space,
open metal plates in which the names of patients can be
easily placed. These racks cost very little and have
proved very satisfactory.
Youngstown Hospital, Youngstown, Ohio
The Youngstown Hospital, of which Mr. Fred S. Bunn
is superintendent, has a young but healthy offspring in
the form of an evening pay clinic for venereal diseases,
which is held once a week. It is being displayed with
considerable pride by Miss Lucy C. Catlin, the hospital's
social worker. It was born on January 21, out of the
throes of a desperate need for some means of taking care
of the hospital patients having venereal diseases. Note
its steady growth. In January it had 11 patients; in Feb-
ruary, 27; in March, 35; and in April, 44. Its total col-
lections up to that date were $265.85 ; its total expendi-
tures $229.65, leaving a balance on May 1 of $36.20. All
veneral disease cases are referred to this clinic from the
day clinic; consequently some free cases are treated in
the evening. Nevertheless, it is more than meeting ex-
penses. While this clinic is considered part of the dis-
pensary work, the accounts and money are kept entirely
separate, so that the hospital may ascertain how nearly
self-supporting it is. The experience of the Youngstown
Hospital Association in beginning its evening pay clinics
should encourage other hospitals to start similar clinics.
Iroquois Memorial Hospital, Chicago
Reports from Chicago's first municipal venereal clinic,
which was started on January 7 of this year at the Iro-
quois Memorial Hospital, show results of the most satis-
factory and encouraging character. These results, ac-
cording to the commissioner of health of Chicago, are in
large measure due to the helpful cooperation given by
physicians and institutions of the city interested in vene-
real prophylaxis.
The clinics are held daily from 6 p. m. to 8 p. m. Tues-
day is reserved exclusively for women. Advice and in-
formation are given to all and free treatment to those
unable to pay.
Few things are harder to put up with than the annoy-
ance of a good example. — Mark Twain.
30
THE MODERN HOSPITAL
GZ50
Hospital Disintegration or Hospital Conservation
—Which?
The civil hospitals of the country are being
gripped by destructive forces. The tendency to
disintegration, hardly perceptible in the first
months of the war, is now rapidly gaining mo-
mentum. It is clearly the duty of those who are
conscious of this tendency to examine its causes
and, if possible without injury to the military
power of the nation, to oppose it.
An effective medical staff is indispensable to
the success of the army. Behind the army stand
the medical and nursing corps; behind these, the
medical and nursing professions; and behind
these, the hospitals in which doctors and nurses
must be trained. There is sound military reason,
then, for asking that steps should be taken to
maintain hospital efficiency throughout the war.
The appointment of a national food adminis-
trator is the executive expression of the doctrine
that "food will win the war." Without develop-
ing and making effective use of adequate trans-
portation facilities, we cannot win the war, and
the President has therefore appointed a director
general of railroads. We are told that fuel is an-
other essential factor, and in keeping with this
idea we find that a fuel administrator has been
on the job for many months. Without a rapid ex-
tension of various war industries we cannot win
the war, and a war industries board is corre-
spondingly busy. In the last analysis it is men
who will win the war, but a health administrator,
to insure a sufficient supply of healthy men, has
not yet appeared on the scene. Congress has con-
ferred upon the President the power to act. Is
it conceivable that he will fail to do so?
I shall not attempt to indicate all that a health
administrator might do to add to the efficiency
of the nation in war. I wish, however, to enumer-
ate a few of the talks that would immediately com-
inend themselves to the consideration of a wise
national health administrator, in the hospital
field alone :
To standardize hospital staffs in order that every hos-
pital might retain in its service the actual number of men
required for the care of its patients, and no more.
To complete the organization of the volunteer medical
service corps, and to prepare to use the members of the
corps to fill dangerous gaps in the service of hospitals,
dispensaries, and civilian communities.
The formulation of a plan for the joint use of special-
ists by civil hospitals and by the military hospitals which
are being established to care for returned soldiers. (Aus-
tralia is profiting by a part-time arrangement; why should
not America?)
To find the means, both men and money, by which dis-
pensaries can be kept going.
To arrange for the training of a sufficient number of
medical students to keep up the supply of graduates
needed by the army and the civil population. (The schools
are now graduating about three thousand men annually.
Inasmuch as there are nearly one hundred and fifty
thousand practicing physicians in the country, and since
the average professional life of a physician is about thirty
years, it will take nearly five thousand graduates per an-
num to maintain the existing ratio between the population
and the profession, without making any allowance for the
growth of population.)
To provide interns for the hospitals which have none
at present.
To invite the Medical Department of the Army to re-
consider its assumption that a single year of clinical
training is ample.
To prevent the further breaking up of the teaching
staffs of nursing schools.
To take steps to create an adequate supply of pupil nurses.
(According to the survey of the American Nurses' Asso-
ciation made during the period September, 1917, and
March, 1918, Massachusetts, with places for 860 proba-
tioners, enrolled in the fall of 1917 only 509; Connecticut,
with places for 522, enrolled 205; New York, with places
for 3,349, enrolled 1,761; Indiana, with places for 529,
enrolled 210; Minnesota, with places for 860, enrolled 509;
Texas, with places for 1,200, enrolled 226.)
To promote a uniform system of legislation for the
training of bedside attendants.
To arrange with the civil hospitals for the training of
a large reserve supply of volunteer war nursing aids.
To discover a means whereby hospitals can successfully
compete in the labor market against inflated war indus-
tries.
To see to it that the government does not unnecessarily
hoard medical and surgical supplies to such an extent that
THE MODERN HOSPITAL
31
civil hospitals are left without surgical instruments, sur-
gical dressings, anesthetics, and medicines. (The justice
of providing for our soldiers first is conceded; but the
necessity of laying by supplies equivalent to ten times the
estimated consumption of the current year is question-
able.)
To urge the government, in framing war tax legisla-
tion, to stimulate rather than to discourage donations and
bequests to hospitals.
To come to the relief of communities which, as a result
of the war, are left without adequate medical and nursing
service.
It is only by facing these problems now and by
finding a speedy solution of them that the impair-
ment of hospital efficiency can be avoided. Hos-
pital efficiency must be maintained, because the
efficiency of the medical and nursing professions
is dependent on it and on these, in turn, depend
to an appreciable extent, the vitality of the nation
and its effectiveness in war.
S. S. GOLDWATER. M.D.
Mobilization of the Civil Hospitals and Allied In-
stitutions for National Service
To win the war and to repair the havoc made
by the war must from now on be the chief end
of existence for everyone. This means you and
me as well as other folks; it means hospitals as
well as other institutions. In order to justify
their existence, the hospitals must do more than
meet the demands of their own self-interest —
more than meet the standards of organization and
administration.
The civil hospitals have their part — and a very
important part — to play in winning the war. It
is true that many of them have already made
great sacrifices. Some have sent the best part of
their medical, nursing, and even their domestic
personnel into army service. What more can they
do, besides making the best of the hardships
which the war inflicts on all of us ? A great deal,
and in particular three most important — nay, in-
dispensable— things.
In the first place, the hospital is the workshop
of the physician and the school of the nurse, and
these two, the physician and the nurse, stand
closer than the men and women of any other pro-
fessions to the soldier in the trenches. The hos-
pitals must train nurses, and more nurses, and
then more nurses. They must replace medical
men and male employees by women wherever pos-
sible. Wherever the services of attendants and
volunteer workers can with safety be employed,
they should be utilized to release interns and
nurses. Graduate nurses, moreover, should not
be encouraged to remain on hospital cases which
could safely be placed on general care.
In the second place, hospitals, by giving efficient
civilian relief, can do much to sustain the morale
of our armies. E.\perience in the armies of our
allies has shown that the one thing which is most
disastrous to the morale of the fighting man is
the worry concerning the welfare of his family at
home, and that no greater help to his courage can
be given than the assurance that those he has
left behind will be cared for when the need arises.
The military authorities tell us that a definite sys-
tem of civilian relief which will provide hospital
care for the families of soldiers will be of im-
measurable value in maintaining the courage of
our men in the army and navy.
In the third place, the hospitals can render
efficient service by cooperating with the army
medical examining boards. Many hospitals are
giving splendid assistance to the medical examin-
ing boards. Others are considering first their own
convenience and, in consequence, examining
boards in many places are seriously handicapped
in the work by a lack of proper quarters and
equipment. The men on these boards are giving
of their valuable time and experience and deserve
the support of the hospitals. This, too, is a part
of national service. It is an important part of
the war machinery and should be assisted by the
hospitals wherever possible.
To sum up: What can the civil hospitals do to
help win the war Train nurses — more, and then
more nurses. Release those in the hospital who
are needed for service elsewhere. Give civilian
relief. Assist the medical examining boards.
These are the things that the civil hospitals can
do now.
Some Practical Papers
A number of especially timely and practical ar-
ticles on everyday hospital problems are pub-
lished in this issue, and more are soon to follow.
Among those appearing this month are the paper
by Miss Mary A. Jamison, superintendent of Grant
Hospital, Columbus, Ohio, on "Hospital House-
keeping," in which she describes the housekeeping
methods which she has found effective in her ex-
cellent hospital; that by Miss Nell Shilt, super-
visor of surgical supplies at Lakeside Hospital,
Cleveland, on the subject, just now of such special
importance, of washing used surgical dressings;
that by Dr. Malcolm T. MacEachern, superintend-
ent of Vancouver General Hospital, Vancouver. B.
C, on "Conservation of Drugs and Other Sup-
plies" ; that by Mr. Pliny 0. Clark, superintendent
of Ohio Valley General Hospital, Wheeling, W.
Va., on "Hospitalism — Its Causes and Treatment";
and that by Mr. Joseph Geffen, superintendent of
Mount Sinai Hospital. Philadelphia. Penn., on the
32
THE MODERN HOSPITAL
often vexing problem of "Visitors and Visiting in
Hospitals." A very practical discussion of the
subject of "The Standardization of Hospitals for
the Insane" is furnished by Dr. William C. Sandy,
assistant superintendent of the Connecticut Hos-
pital for the Insane at Middletown. Dr. Sandy,
it may be remembered, made for the National
Committee for Mental Hygiene a survey of Penn-
sylvania county asylums, the results of which
were published last year.
Two papers soon to be published on important
problems arising out of war conditions are one
on "The Trained Attendant," by Miss Florence
Dakin, superintendent of the Middletown Hospi-
tal, Middletown, Ohio, and one on "The Night Pay
Clinic," by Dr. A. R. Warner, superintendent of
Lakeside Hospital, Cleveland.
Miss Dakin discusses the crisis in the nursing
situation produced by the urgent call for trained
nurses for the national service. She suggests
that many of the difficulties arising out of the
present situation may be obviated by establishing
training schools for attendants in the small gen-
eral hospitals of from fifteen to fifty beds. The
attendant should receive a certificate only — not
a diploma — at the end of the prescribed course,
and should not be permitted to represent herself
as a trained nurse. This solution of the problem
will be viewed with misgiving by many hospital
authorities, but this exposition of the plan, by the
superintendent of a hospital in which it has been
put into successful operation, is worth a careful
reading.
Dr. Warner describes another innovation which
would doubtless have been vigorously opposed not
long ago. War conditions, however, are demon-
strating the absolute necessity of some provision
for meeting the needs of the self-respecting work-
ingman, who cannot afi'ord to pay specialists' fees,
yet shrinks from becoming an object of charity.
Dr. Warner shows that the night pay clinic does
not compete with the general practitioner — or,
for that matter with the specialist — because the
work done by the clinic would otherwise either not
be done at all, or would be done for nothing or at
a loss. On the other hand, the night pay clinic
physician receives a remuneration for his work
which is not only fair, but well above that re-
ceived by the average physician in private prac-
tice. As Dr. Warner says, "the exigencies of war
may in the near future compel the establishment
in many communities of organized practice of
medicine to provide medical care not only for the
workingman but for all the civilian population."
He adds that the pay clinic seems especially well
adapted to the small hospital. We feel justified.
therefore, in commending this article when it ap-
pears, to the serious attention of our readers.
Another very timely and practical paper to ap-
pear soon is one by Miss Caroline L. Butterfield,
superintendent of Martin's Ferry Hospital, Mar-
tin's Ferry, Ohio, on the solution of the house-
keeping problems of a small hospital in an indus-
trial community where wages have risen to an
almost prohibitive point. Miss Butterfield's in-
genious methods of meeting the difficulty by the
use of labor-saving mechanical devices, etc., will
be of much general interest.
Other practical papers scheduled for the future
include one by Miss Mary E. Lewis, whose excep-
tional work at Grant Hospital, Chicago, is de-
scribed by Miss Robinson in this issue, on ways
of conserving the energies of the night superin-
tendent ; one by Mr. Charles T. Hoblit, farm, gar-
den, and dairy consultant to the Illinois Depart-
ment of Public Welfare, on the work of the farm,
garden, and dairy consultant to the institutions ;
and one by Dr. H. E. Tuley, superintendent of the
Louisville City Hospital, on the way in which a
large number of administrative problems have
been satisfactorily solved in that institution.
In this connection, a number of interesting
papers on increasing the usefulness of the hos-
pital records, the library, and the annual report
should be mentioned, but limitations of space for-
bid for the present. We shall have more to say
about the articles on these and other subjects
a little later.
More Laboratory Technicians Needed
The need for laboratory technicians has grown
with the need for laboratories. Time was when
a physician guessed at a diagnosis or the need
for surgical interference, or did the best that he
could to make his diagnosis from symptoms and
physical findings alone, but laboratory facilities
for diagnosis are as necessary a part of a hospital
today as are its operating rooms and its kitchens.
Keeping pace with the movement for the stand-
ardization of hospitals is the demand for labora-
tories and for some one to do the work in those
already existing, and in those to be installed to
meet the requirements for classification. Hos-
pitals in all parts of the country are asking,
"Where may we procure a roentgenologist?
Where may we procure a pathologist ?"
Many medical men who were doing the labora-
tory work for their hospitals are now in service.
Interns are at a premium. Many of the large hos-
pitals which usually have a large number on their
resident staff now have very few, and many of the
smaller institutions which have one or two under
THE MODERN HOSPITAL
33
ordinary conditions now have none at all. Even
in normal times previous to the war it is doubtful
whether the number of trained laboratory work-
ers, medical men, interns, or technicians kept pace
with the increasing demand for laboratories. The
present need is emphasized by the announcement
from the Surgeon-General of the Army that one
hundred women bacteriologists are needed to
take the place of men in the cantonment laborato-
ries. This shortage of technical workers may last
for some time to come, and it seems that unless
some special effort is made to fill the ranks, it may
become impossible to utilize this important factor
in the adequate diagnosis of disease and the good
service to our patients in places where good work
had already begun.
This work has really become a specialty in
itself, not necessarily attached to the profession
of medicine or the degree of bachelor of science.
Yet comparatively few of the educational centers
are offering laboratory courses which will espe-
cially fit the student for work in the hospital labo-
ratory, and still fewer offer special courses avail-
able for the training of technicians.
The larger hospitals, which have complete labo-
ratories and teaching facilities connected with
training schools for nurses, could give, during the
senior year, a definite short course in laboratory
work, and after gi-aduation this could be continued
as a special post-graduate course by those who
had proved their adaptability and their desire to
enter the field. The Catholic Hospital Association
plans to give courses to the sisters in hospital
service during the summer months. If other
agencies and teaching hospitals meet this problem
as fairly the need wall soon be supplied.
The field seems to be one in which women have
proved their usefulness. Numbers of gi'aduate
nurses have made good laboratory technicians,
and if sufficient educational advantages are of-
fered to them to enter upon this special training,
they will in time fill the gaps in the ranks.
Compulsory Universal Service — A Ministry of
Health
A rather noteworthy "Plea for Universal Serv-
ice," by Edred M. Corner, F. R. C. S., surgeon to
St. Thomas's Hospital, London, appears in a recent
number of the Lancet. Because it carries even
further certain suggestions made in these col-
umns some months ago, as well as because it pre-
sents briefly some very important considerations
which the nations will have to ponder at the end
of this war, we call attention to it here.
The examination of British recruits under Lord
Derby's scheme, we are told, almost invariably
disclosed physical deficiencies of weight or height
or inefliciency due to disease. Under our industrial
system, youths reach maturity blemished by dis-
ease ; men grow aged when they should be in their
prime. In many vocations, as we on this side of the
water know too well, in his fortieth year a worker
is reckoned an old man. Why is this?
"The core of the matter is," says Mr. Corner,
"that men in the working masses wear out earlier
than in other classes, not because they are worse
men, but mainly because they have no break in
their work, no rest, no change, from the day they
leave school to take up a trade till the day they
cease working for good and all. This tends, per-
haps more than anything else, to narro\vness of
sympathy and bitterness of heart. Can one feel
surprised at the unfairness and deep hates of in-
dustrial troubles? This unrest is a very real and
great social danger which can be largely averted."
Physical culture — compulsory physical culture
— is the remedy, in Mr. Corner's opinion. It will
not do to leave such a vital matter at the option
of the individual. Like vaccination and educa-
tion, such physical culture must be compulsory
and universal, nor can it be allowed to stop with
the school child. "There is only one method that
I know of rejuvenizing and morally cleansing the
nation — universal service, a system of drill and
physical culture for men and women. Do not
let it be termed conscription — that is a conten-
tious word — but universal service, which, by im-
proving the individual, preventing his aging, in-
creasing his health, power, and ability, adds to
his value to his family, his polity, and his nation
— that is what is meant. ... It would be
wrong to claim that universal service would rid
us of the whole of this great secular and industrial
evil ; but to say that it would help to diminish it is
only the truth. It would be an immensely gi'eat
economic gain to all."
Team-work, Mr. Corner goes on to say, is the
greatest educator of the human race that exists.
Commerce allows the individual to woi-k for him-
self alone and thereby may induce national decay.
War, destructive as it is, encourages teamwork
and may thus tend to cure the dry-rot of indi-
vidual selfishness. Yet this destructive remedy
may be worse than the disease. In universal serv-
ice alone may be found the combination of con-
structive effort and team-work necessaiy for na-
tional well-being. "Not war but universal service
is the cure for national ill health." Corner, in
short, has rediscovered James' "moral substitute
for war." Nor is he the first since James to have
made such a suggestion ; but the world has
34
THE MODERN HOSPITAL
listened with amused tolerance to all such "vision-
ary dreams" of philosophers and humanitarians
and has turned away from them to the "practical
business" of things as they are — as they were !
As they were — and never shall be again ! Make
no mistake; never was there a more unpractical
world than that which has broken down in the
deadliest and most gigantic of all fiascoes of his-
tory. Hereafter statesmen and "practical people"
will perhaps regard with less foolish scorn and
shipshod, unthinking, misnamed conservatism, all
proposals for social betterment. We venture to
predict that something similar to "universal com-
pulsory service" is going to receive serious consid-
eration in the reconstruction of the world after
the war.
Need for Hospital Executives in Red Cross Work
We ventured the prediction some time ago that
the day of opportunity for the progressive super-
intendent was not far away. This day of oppor-
tunity is already here; the only question seems
to be as to the number of executives who are
prepared to take advantage of it. The demand
still continues for superintendents capable of tak-
ing charge of Red Cross hospitals in France and
of government hospitals here and abroad. We
have had of late a number of requests, which we
have been unable to supply, for the names of
candidates for such positions. We would suggest
that any superintendent desirous of undertaking
government or Red Crass work send to this office,
inclosing a stamped addressed envelope, for a
blank form which, when filled out and returned
to this office, will be placed on file for reference
in connection with applications for executives in
such work.
Some Last Minute Confidences
An unexpected influx of important and timely matter
for several of our departments has made it necessary to
reduce somewhat the number of leading articles this month.
It has been necessary, in particular, to postpone until
August the initial instalment of the series of articles on
"Hospital Accounting," by Charles A. Porter and Herbert
K. Carter. By way of compensation, some exceedingly
interesting and valuable articles are presented under de-
partmental headings. The Bulletin of the American Hos-
pital Association contains a rather full report of the con-
ference held under the auspices of the war service com-
mittee of the American Hospital Association, on subjects
of vital importance to hospitals under war conditions. We
wish also to call special attention to the article in the
same department on "The War and Interns in Special
Hospitals." This should be taken to heart as a message
from the Surgeon-General's Department to all concerned,
whether members of the American Hospital Association or
not. In fact, everything in this month's Bulletin of the
American Hospital Association should be widely read by
members and non-members alike. In connection with the
reports of several interesting association meetings which
appear this month, there is room here only to say that the
keynote of most of the important meetings is the subject
of the reconstruction, rehabilitation, and reeducation of
the handicapped, whether from war, from accident, or
from disease. In view of the growing importance of the
subject, these meetings have a very vital and general
interest.
Hot Tea for the Men in the Trenches
"In addition to hot meals which are carried to the sol-
diers in the trenches," says Maj. George de Tarnowsky,
writing in the Review of Surgery and Medicine, "the
Medical Corps now sends hot tea, flavored with a small
amount of brandy, to the front lines twice daily — a most
welcome potion, which the soldiers look forward to with
eagerness. The prevailing idea of the French Medical
Corps is to make the fighting men feel and know that their
comfort is being looked after and that everything is being
done to mitigate the hardships under which they live.
The French are strong believers in the personal element —
the little acts of kindness, even of tenderness, towards the
individual soldier which have helped to keep up both his
fighting spirit and his mental serenity. The 'tisaneries,'
as the hot tea stations are called, did not come into exist-
ence as the result of army orders; they represent a volun-
tary contribution to the soldier on the part of the Medical
Corps. Begun in a small way, it was soon noticed that,
where the tisaneries existed and the regimental kitchens
were installed near enough to the trenches so that the food
reached the soldier hot, the morale and fighting edge were
of the finest."
An appropriation has been secured for the Initial unit
of the new building for the University Hospital at Ann
Arbor, Mich. The capacity of the present building is 400;
that of the new building will be 1,000. It will be ex-
clusively a teaching hospital. There is at present a daily
waiting list of 50, the patients coming not merely from
the vicinity of Ann Arbor, but from' all over the Middle
West, thus showing that it is not necessary that a teach-
ing hospital be located in a large city.
Dr. Noboru Ishida, author of the article on "The Non-
Restraint System in the Insane Wards of Nagasaki Hos-
pital," published last month, wns elected an honorary
member of the American Medico-Psychological Association
at its recent meeting in Chicago. Dr. Ishida intends to
establish communication between the American Medico-
Psychological Association and the similar society existing
in Japan. Readers of Dr. Ishida's article in The Modern
Hospital will be interested to know that Dr. Ishida is the
author of the most popular text-book on psychiatry used
in Japan, which has gone through seven editions and is
about to be issued in an eighth edition. Dr. Ishida says
that his advanced ideas in regard to non-restraint of in-
sane patients were at first much opposed by government
officials, whose respect for precedent caused them to throw
many obstacles in his way. He now finds no difficulty in
extending the application of the non-restraint principle.
The two features of American psychiatric hospitals
which particularly impress themselves on Dr. Ishida are
their great size and complete equipment and the sympa-
thetic understanding of the insane shown in their treat-
ment.
THE MODERN HOSPITAL
35
BULLETIN OF THE
AMERICAN
HOSPITAL ASSOCIATION
Monthly Bulletin issued from the Executive Office
7i8 Seventeenth Street. N. W.. Washington, D. C.
WILLIAM H. WALSH. M. D.. Secretary.
WAR SERVICE COMMITTEE CONFERENCE
Important Discussion of Hospital Problems Arising Out of
the War
A conference on hospital problems resulting from the
war, held under the auspices of the War Service Commit-
tee of the American Hospital Association, met at the New
York Academy of Medicine, June 3, the chairman, Dr. S.
S. Goldwater, presiding. Others who were present were:
Mr. Richard P. Borden, War Service Committee, Dr.
John W. Brannan, Bellevue and Allied Hospitals, Dr.
Samuel A. Brown, dean. University and Bellevue Hospital
Medical College, Mr. F. S. Bunn, president, Ohio Hospital
Association, Dr. Henry A. Christia:-., Peter Bent Brig-
ham Hospital (Harvard Medical School), Dr. Pliny
0. Clark, secretary. West Virginia Hospital Association,
Miss S. Lillian Clayton, president. League of Nursing
Education, Miss M. H. Combs, Hospital Social Service
Conference, Lieut.-Col. C. H. Connor, M.C., assistant direc-
tor general, Department of Military Relief, American Red
Cross, Dr. E. R. Crew, secretary, Ohio Hospital Associa-
tion, Hon. Augustus S. Downing, assistant commissioner
of education. New York State, Miss Susan C. Francis,
American Red Cross, Philadelphia, Mr. Charles B. Grim-
shaw, Roosevelt Hospital, Maj. John A. Hartwell, M.R.C.,
Cornell Medical College, Lieut-Col. John A. Hornsby, rep-
resenting Surgeon General Gorgas, Dr. Thomas Howell,
president, Hospital Conference of the City of New York,
Dr. Joseph Howland, Boston Hospital Committee, Dr. O.
V. Huffman, dean, Long Island College Hospital, Dr.
C. H. Lavinder, representing Surgeon-General Blue,
Dr. E. H. Lewinski-Corwin, Public Health Committee,
New York Academy of Medicine, Prof. James P. Mun-
roe, Federal Board for Vocational Education, Mr.
James Norris, Presbyterian Hospital, Dr. G. W. Olson,
president, Minnesota Hospital Association, Dr. Henry
Page, Philadelphia Hospital Committee, Dr. R. M. Peters,
Providence, R. I., Dr. Renwick R. Ross, Buffalo Hospital
Committee, Dr. Alice Seabrook. Philadelphia Hospital
Committee, Dr. Ralph B. Seem, Baltimore Hospital Com-
mittee, Dr. Alfred Shipley, Medical Advisory Committee,
American Red Cross, Mr. Daniel D. Test, War Service
Committee, Dr. A. R. Warner, War Service Committee,
Mr. Henry C. Wright, State Charities Aid Association.
The chairman. Dr. S. S. Goldwater, in opening the meet-
ing, expressed his thanks to those who had responded to
the call to attend this meeting, which represented the be-
ginning of an important movement in the interest of the
civil population and the government. It was the wish of
the War Service Committee, in the present or future con-
ferences, to reach some definite conclusion in regard to a
long list of pressing problems, which were enumerated in
the program as follows :
Medical Service. — Visiting Staff: Extent of military enrollment to
date: Proper limitation of future enrollment (standardization of hos-
pital staffs as a preliminary) : Volunteer medical service corps (avail-
ability for civil population) : Possibility of part-time military service
(requirements at great ports of debarkation and at reconstruction hos-
pitals).
Dispensary Staff : Can voluntary service be maintained : Will the
government or Red Cross aid?
Interns : Withdrawals to date : War-time standards : Commissions
and the period of inactive service : Maintaining a graded service : How
can the smaller hospitals obtain interns : How can the special hospitals
obtain interns ?
Medical Students: Keeping up the supply for army purposes: Re-
quirements of civil population.
Nursing Service. — Withdrawal of graduates and supervisoi-s : Supply
of pupils (shortage shown by survey of American Nurses' Associa-
tion) : How will the new army training school affect existing schools:
Should the three-year course be abandoned ? Available registered gradu-
ates : How should attendants be used and controlled ? Voluntary Aids
as an emergency force.
Labor Supply. — Actual shortage of paid workers: Can private hos-
pitals secure labor in the face of competition of government and of
war industries ? Use of volunteers.
Medical and Surgical Supplies. — Need of stimulating production and
regulating distribution: Where will next year's instruments come fi-om?
Income and Expenditures. — Effect of war taxes on donations and be-
quests : Proposed exemption of legacies from Federal inheritance tax :
Can the hospitals make both ends meet during the war: Should Red
Cross aid or governmental relief be sought ?
New) Construction. — Needs of civilian population: Should cii>iL .hos-
pitals attempt to build now ? Will the government facilitate construc-
tion? To what e.xtent can emergency (army and navy) construction
be made permanent and of subsequent use to municipalities ?
Care of Government Patients. — Army and Navy: Emergent cases:
Returned (invalided) soldiers and sailors: Location and capacity of
army and navy hospitals : Use of civil hospitals : Compensation to hos-
pital : Compensation to staff.
Federal Vocational Board : Cooperation with civil hospital : Special
equipment : Training of teachers in existing hospitals.
War Risk Insurance Bureau: Use of city hospitals for in-patients:
Care of out-patients: Compensation.
"There are many topics outlined for discussion and it
will probably not be possible to debate all of them exhaus-
tively, but we shall try, at least, to get a clear conception
of the character of the crisis we are facing. We have
with us this morning representatives of hospital organiza-
tions in the principal cities of the country, of medical
schools, and of various national committees and depart-
ments of the Federal Administration."
Dr. Goldwater then presented a plea for the appoint-
ment of a Federal Health Administrator, and indicated
the problems that would confront such an official in the
field of hospital administration alone.
Mr. Rich.\rd p. Borden : There is approaching the pos-
sibility of an absolute exhaustion of the supply of medical
men for the army. In all the medical journals there ap-
pear constantly appeals to medical men to volunteer for
the service. In the nature of things, the present supply
of medical men in this country can be supplemented only
in one way and that is by thorough education of medical
students, Aot only in the medical schools and colleges, but
by courses as interns in hospitals.
Early in the year, a study was made by the medical
section of the Council of National Defense as to the avail-
ability of physicians in the country. That was supple-
mented by an inquiry by the War Service Committee as
to the bed capacity of the hospitals of the country, the
number on the visiting staffs, and the status of interns.
It has been difficult to compile the returns because condi-
tions vary over the country. One small hospital in a small
town had a visiting staff of twenty men ; it was an open
hospital and all the medical men in the vicinity were on
the staff. Other hospitals had very small staffs, differ-
ently organized. About 20 percent of the physicians in
the country appear to be men of valuable hospital experi-
ence, and practically 20 percent of the hospital staffs have
already entered the service.
So, at the beginning of the year, it seemed clear that,
as far as competent physicians were concerned, nearly all
the men who could be used to advantage in government
service were already enrolled. There is in the rooms of
the Medical Section of the Council of National Defense a
chart showing the curve of enrollment of physicians in
the army. At the beginning the curve is very high; when
thf- profession was first called upon, men volunteered
quickly; since then the curve has been constantly drop-
ping; the last time I saw it the number enrolling monthly
was less than three hundred. They tell me the monthly
36
THE MODERN HOSPITAL
enrollment should be at least five hundred. The question
is how and where these men are to be obtained.
In a questionnaire, hospitals were asked to give opin-
ions, in addition to figures, as to the hospital situation.
All the answers were to the effect that the situation regard-
ing interns was very serious. The larger hospitals were
managing to keep up their supply of interns fairly well,
but in the smaller hospitals the interns had disappeared.
Some were using medical students and some women physi-
cians, but even the supply of women physicians was being
exhausted.
In the last draft legislation, medical students were ex-
empted from the draft so long as they remained medical
students, but interns were not included, though by an ar-
rangement through the surgeon-general's office there was
an understanding that interns should be allowed to remain
in the service of recognized hospitals for one year, pro-
vided the entrance was not postponed too long after the
receipt of a diploma. An unofficial intimation was given
in the surgeon-general's office that the interns might be
allowed to remain in the hospitals longer than one year
if circumstances permitted, for they recognized that it
was extremely desirable from the point of view of the
army that young men should be thoroughly trained before
being sent out to treat our soldiers.
Another point is, what would be the situation of an in-
tern in a special hospital, tuberculosis, insane, women,
children, etc.? The regulations issued at Washington
called for internships in general hospitals exclusively. The
War Service Committee took that up with the surgeon-
general's office and at an authorized interview it was
stated that the probable policy in all our hospitals, except
those for women, would be the same recognition as if in a
general hospital. Women's hospitals were excepted be-
cause the training was not suitable for military purposes;
men who are unfit for active service should be induced by
the medical schools to seek internships in the women's
hospitals, while young men able to perform military duties
should avoid them.
EflForts should be made now to conserve the supply and
provide for the education of the coming members of the
profession ; to see that the organization of hospitals is not
disrupted ; and to make available those men who must
remain at home to carry on the work of the medical
schools and instruct interns and nurses in the hospitals.
It is the duty of a proportion of the best men in the pro-
fession to stay at their posts in order, as need increases,
that other men will be educated for duty as the war goes
on. General Gorgas has said that the cream of the medi-
cal profession is now in the army; this was intended as a
compliment to the medical profession, but it implies that
only the skimmed milk is left to draw upon. Is there
wisdom in such a program? As representatives of the
American Hospital Association, we recognize the need of
the people for hospital service, and we believe that the
organization of the civil hospitals should not be disrupted
by too free use of the talents necessary to continue those
institutions in efficient operation.
Dr. Brown : I think the threatened disorganization
is due largely to lack of vision. The remark of the
surgeon-general that the cream of the profession is
now in the army is a reflection on the stay-at-home physi-
cians. They tell us in one breath that teachers are neces-
sary and must remain at their posts, and next that the
cream of the profession is in the army! We ask what
is the definite and positive plan for the control of interns;
they reply that interns can serve one year; then they say
three or four months is sufficient. Only the hospital au-
thorities know whether a man is fit for medical duty at
the end of a stated period. Some men require longer hos-
pital service than others. I think there should be some
way in which the hospital could say a man was prepared
or not prepared to go into the service. Thirty or 40 per-
cent of the interns who have joined the Medical Reserve
Corps have not completed a year in hospital.
I think the question of accepting for the Medical Re-
serve Corps members of the visiting staff of hospitals or
colleges should be referred back to the hospital or college
for consideration. This would make it possible to release
those whose work can be done by others and to keep those
whom it is impossible to spare. There should be some
recognition of the men who are doing teaching; we shall
not be able to hold these men unless their work is recog-
nized.
Dr. Christian: The problem of the medical schools
is where the next year's freshman class is coming from.
The only provision I can see is for men in college who
have had one or two years of the necessary preliminary
training and who are far enough away from 21 to feel
that if they start in the medical school they can get a rea-
sonable amount of medical education before they are
drafted. But that, probably, is not a large number. A
student is likely to say, "There being no assurance that
if I start in medicine I can finish, I will go immediately
into active, non-medical service."
The remaining service of medical students next year is
derived from the physically unfit; of those we shall get a
certain number, but not a large number. The government
should now decide how many students they wish to have
in the medical schools next year and should then provide
for them.
There are other problems confronting us. One of them
is how to stop the stampede of medical students into active
service. When the student is enrolled in the Medical
Corps, he is told he can transfer to some other branch on
petition. Every now and then a student gets it into his
head that he would like to go, for instance, into aviation,
and in his enthusiasm he starts a stampede. The govern-
ment should reduce the number of such transfers.
In regard to the intern year, one plan that might be
considered is the inclusion in the four years in medical
school of four months of intern service. That may prove
to be necessary. It should be recognized, however, that
this means less medical school education and less intern
preparation ; that is, it is not a full medical course or
full hospital service, but some medical course and some
hospital service. If the government needs men so badly
as to be able to use poorly trained ones, that is the way
to get them. Otherwise, it is most desirable to continue
the full four-year medical course and one-year hospital
service.
In Boston, the men have been allowed to complete their
full hospital service, but we hear from other cities that
men are called to service notwithstanding the fact that
they were registered as interns. Such news disquiets
medical students; they say they had better get a good
commission now rather than start in hospital service and
get only the first part of it, which is made up of rather
unattractive routine work. If the government is not going
to require the twelve-month service, the hospitals should
be told so that they can adjust their service. We can
attain the required grade of service with the twelve-
month time allowance, but if we have only part of the
men for twelve months it will be impossible to maintain
a graded service.
Owing to the scarcity of medical personnel, we have
found it useful in Boston to employ a large number of
technicians to do laboratory work. In addition, we are
training women. That is an added means of getting
around our difficulties; thei-e is an opportunity for the
medical schools to help by using their laboratories for the
teaching of technicians.
Mr. Bunn : We have lost a number of men from
Youngstown, and are finding that the use of nurse and
anesthetists and technicians in the laboratory is helpful.
We are putting in dictaphones for taking histories on
account of the diminished intern service. The hospitals
in Ohio are laboring under a tremendous disadvantage.
There are 7,800 physicians in the state, of whom 1,000
are in the service. Dr. Freeman said last week that the
ones taken out were among the most efficient ones; the
7,800 includes many retired, some antiquated, and institu-
tional appointees, so that at least one-sixth of the total
number of those actually in practice could be said to have
been withdrawn. Ohio's quota of nurses is 3,500, and
1,500 are in service, so that here also we are suffering
from shortage. We have only about one-half the number
of interns we had before the war.
Dr. Ross: I think the intern service in many hospitals
could be simplified. The intern has too much clerical work
to do outside of that purely medical. This could be turned
over to other employees. Lay people can easily be taught
to take histories, write up operations, do laboratory work,
etc., and, without lowering very much the standard of
hospital work, we can reduce the number of interns by
one-third.
Dr. Seabrook: The women have been coming into the
work and filling the demand as far as possible, but there
THE MODERN HOSPITAL
37
are not enough to go around. We have felt the stress in
my hospital. During this last year, instead of eight in-
terns, I have been working with five. This year I expect
to have my full quota, but I do not know what next year
will do. I think the work, as Dr. Ross suggested, can be
so arranged that much can be taken off the intern's shoul-
ders by others.
Dr. Goldwater: In comparing hospitals with each
other we must consider actual conditions. The large hos-
pital may spare a certain proportion of its intern staff.
The small hospital needs its one intern badly, and it is
precisely the small hospital which is suffering the largest
losses. As to visiting staff, there should be same stand-
ardization. A hospital with a "continuous" service or-
ganization can perhaps spare 20 percent of its attending
staff; a hospital with a "rotary" service, where four men
during the year, each serving three months, do the work
of one, can spare two or three times as many. It is a
question whether the rotary service ought not to be abol-
ished during the war.
LiEUT.-CoL. Hornsby: I can, perhaps, tell you some of
the things we are talking about in Washington in this
connection. I was sent to this meeting, perhaps, because
I am more the civilian than the military man, thoroughly
in sjTiipathy with the civilian problem. I appreciate the
difficulties of the civil population. These difficulties, how-
ever, did not start with the war. They existed when it
began. The intern question was a perplexing one before
that, largely due to the improvement in the standards of
preliminary education for medical men, and the resulting
elimination of many schools from the medical education.
I have been in the closest touch with the whole country,
by reason of my connection with the war hospitals. It is
not a new problem for the small hospitals to be embar-
rassed for interns. The thing that calls for attention is
the future; the question is, where will we land? We are
making progress, and I think much of that is due to our
recognition of the helpfulness of civilians, such as Dr.
Goldwater, whose help has been invaluable — even when
his advice hui-t it was most valuable. The army some-
times may be thought to be arbitrary and self-sufficient,
whereas, if the whole story could be told, it would not be
found so.
We are doing the best we can with this question of
interns. Ci5lonel Arnold is working day and night so that
we may be in a position to know everything in regard to
the question of distribution, employment, and utilization
of the services of newly graduated men. Something will
probably be done soon with the question of securing medi-
cal students, but I don't think it will be done as Dr. Chris-
tian suggests, by commandeering them. We have a lot of
enlisted men in the Medical Corps of the army, and it
might be found feasible to comb that enlisted personnel
of the Medical Corps for men eligible for the medical
schools. Many are educated men who, having been given
the option of going into one or another branch of the
service, have chosen the medical enlisted branch.
As for the increase in the medical forces, fully 10 per-
cent of the active physicians of the country are in uniform
at the present time. That means more than 10 percent of
the eligible men, men out of practice, and those physically
incapacitated. It is true we have taken many of the best
men, the most active men, because they have been eligible
physically. Up to the present, it has not been felt pos-
sible to take a man for some special service, a man in-
eligible for well-rounded service for overseas work.
It would be desirable, if possible, to make a more ade-
quate distribution of men for military service and take
this or that man and leave a number home. But we are
unable as yet to do this. The only thing we can do at this
time is to accept volunteers except those in the draft age.
The draft law is one of the reasons why many young men
have gone into the Medical Reserve Corps who would
otherwise be loyally and heroically sticking to their posts;
it is heroic to stay back when a fight is going on, but the
draft law is one reason why many are going into the
army.
Mr. Test: They are calling from the housetops that
a man is not patriotic unless he joins the army. It may
require a higher grade of patriotism to stay at home than
to join the colors. I doubt if the surgeon general's office
is responsible so much as the local recruiting offices. The
surgeon-general should let it be known that it is a patri-
otic duty for some to remain in the civil hospitals.
In reference to interns, I do not think the surgeon-
general's office can be censured for taking the men before
they have had a year's service. I believe if the hospitals
had notified the surgeon-general, these young men would
have been allowed to remain. Lately, the surgeon-general
has refused to take them before the completion of their
year of hospital service.
Dr. Rowland: They say the Surgeon-General of the
Army does not take the interns until they have served
a year; but the navy takes them before they have their
diplomas. We have one young man who has received his
appointment in the navy and he will not be graduated for
a day or two.
The idea of lay service to relieve interns of clerical work
is a good one. We started that some time ago and have
at present come to depend on our technicians.
I think a modification of the requirements for a degree,
or even two preliminary years in college would be satis-
factory at present. A man who has a high-school educa-
tion can do well in medical school.
Mr. Borden: If it can be shown that a man has been
taken into the service of the army or the navy before the
close of one year in hospital, his appointment will be
withdrawn. That has happened in several cases.
Dr. Goldwater: It is true that at the beginning the
navy's policy was to take men right out of the medical
schools. The idea was erroneously held that a year in
the navy would be equivalent of a year in hospital. The
result was that when put on the transports, untrained
graduates were found to be totally unprepared or respon-
sible and an effort has since been made to provide for
them, while in port, the opportunity to make up some of
the hospital training they failed to get in the first place,
before being commissioned.
Dr. P.\ge: This matter will have to be regulated by
some centralized authority. Large hospitals in the cities
have no difficulty in getting interns. I get appealing let-
ters, however, from managers of hospitals of fairly good
size to get them at least one intern for the coming year.
We have been working with 50 percent curtailment and
the efficiency of the hospital has not greatly decreased.
In Philadelphia and through Pennsylvania generally we
are in difficulties because by state law we must give an
intern some training in every branch of the service. He
must have laboratory work, so though we employ techni-
cians we cannot always substitute them. It is feasible
to limit the number of interns in any given hospital, but
it is unfair for the hospitals not to be able to get
adequate intern service when the large hospitals could
spare some of their men.
Mr. Test: If some hospitals can spare more men,
they should; provision should be made for distributing
the surplus where most needed.
Dr. Goldwater suggested that the situation could only
be controlled by a suitable federal authority, and asked
the conference to consider the following resolution:
Resolved, That under the direction of a Federal health adminis-
trator or other suitable Federal authority, a program should be pre-
pared for maintaining an adequate supply of medical students and
of properly trained physicians and nurses during the war ; in so far
as the extension of the existing facilities tor training may become nec-
essary, the means for such extension should be provided by the gov-
ernment. Surveys in nursing and medical fields which have already
been undertaken by governmental and private agencies should be ex-
tended, coordinated, and completed. A program should be prepared
and carried out, in cooperation with the military authorities, for the
most effective disposition of students of medicine who are of draft age
and for the modification of their training to meet war requirements.
Medical institutions, physicians, and nurses should be brought under
the direction of the government whenever necessary, to insure adequate
attention to the needs of the civilian population.
This resolution was unanimously adopted.
Dr. Christian : My suggestion in regard to procuring
medical students was misunderstood by Colonel Hornsby.
There are many young men in the colleges who, under
normal condition, would enter the schools this autumn.
My idea is that these men should be allowed the oppor-
tunity to enlist, between the ages of 17 and 21, or up to
the liiaft age, in the Medical Corps, with the understand-
ing that they would be assigned to a medical school, in
the same way the present medical students are working
and that on graduation they should be permitted to apply
38
THE MODERN HOSPITAL
for and receive eommisisons in the medical service. The
surgeon-general's office should state how many medical
students the government thinks should be in the medical
schools next year, and should ask for that number of vol-
unteers for enlistment, with the understanding that with
that enlistment will go their commissions provided they do
good work^that is, they would be commissioned on gradu-
ation.
I suggest that a good deal of what we said about tech-
nicians is equally applicable to the service of commis-
sioned medical men. Former interns now in the service
complain because they are not busy or are treated as
"cheap labor," being given chiefly clerical work and lab-
oratory technician's work. Without in any sense decry-
ing its necessity, should such work be done by men who
are qualified at great expense to do other and more press-
ing tasks?
LiEUT.-CoLONEL HoRNSBY : Many medical officers have
been kept around camps and there is a common complaint
that some have not enough to do. They do not understand
why they have not enough to do when the army is so busy.
The men in the camps are not necessarily there because
they are of real value, but because they must be trained,
and part of their training is in military paper work. This
is fundamental knowledge which they will require when
in active service. Some men are far from appreciating
the fact that they are sent to camp for training and are
overlooking opportunities to get that training. They want
to practice medicine. The army hopes in the course of
a few months to give them a sufficient amount of military
training to enable them to practice military medicine.
There are questions of insurance, pensions, rights of indi-
vidual soldiers, questions of coordination, military meth-
ods and procedures, and it is necessary that that end of it
shall be appreciated by the medical officer.
Dr. Ross: How are we going to get a supply of nurses
for our hospitals?
Miss Clayton : The nursing profession is having
great demands made upon it, and in meeting this need we
feel that we should try to look forward to the future as
well as to consider the present. At the recent convention
in Cleveland we outlined three lines of effort which we
believed would help meet the present situation, one of
which is a military school of nursing. This army school
will help the future of hospitals because there is to be
close affiliation between the army and the civil hospitals.
You ask if we think the army school will affect the civil
hospitals, or reduce the number of their nurses. To some
extent, yes. The training schools short of nurses today
are short of nurses always. Our best schools have no
serious complaint. From those schools we believe we will
draw no nurses. Our army school will admit young
women between the ages of 21 and 25, with high-school
education. There are hospital training schools that accept
young women with only two or three years of high school
education, younger than 21 and older than 25. We be-
lieve the Army School of Nursing to be a good plan. The
teaching will be entrusted in part to the medical men in
the cantonment hospitals, including some of the best phy-
sicians in the country.
Dr. Goldwater: But the medical personnel at canton-
ments will constantly be changed. How, then, can they
form an effective faculty?
LiEUT.-CoLONEL HoRNSBY: As We find the men be-
coming competent to handle their work, they will be sent
abroad. The surgeon-general is not likely to continue
"faculties" anywhere. I was present at the conference
at which the army nursing school was authorized. The
Secretary of War said he would approve the idea of
putting in two or three of these training schools to start
with. If they worked out all right, the general scheme
might be approved in toto. If there were any reason why
the plan should be changed the reason would soon develop.
The army nursing school is not to be considered as a com-
pleted plan, approved at once for the whole army. The
thought was that there being no immediate need to do
otherwise, the Secretary of War was willing to see it tried
out. If it develops that there is need for something else,
that will be done. It seemed to the secretary that thej'e
was no such emergency as would make it impossible to try
out this program for a reasonable period, everyone be-
lieving it a good one if it will meet the needs of the army.
The Secretary of War, therefore, gave the plan his tenta-
tive approval, but conditions in the army are changing so
rapidly that any moment may see the necessity for the
withdrawal of this approval.
Dr. Ross: As I understand it, the Red Cross has asked
for 5,000 nurses from the Atlantic Division this month.
They ask for 250 from our city. Yet Colonel Hornsby
tells us there is no emergency.
Dr. Goldwater: A distinction should be made between
present and future need, and also between the need of
the army and of the Red Cross. The Red Cross has in
mind two things, first of all to help the army, and second,
to meet its obligations toward our allies, whose need of
nurses in both the military and civilian field is great and
insistent. At present there are practically no nursing re-
serves— no enrolled nurses fit and available for immediate
duty, to replace the large drafts which the overseas forces
are making on the cantonments. This accounts for the
urgent call.
LlEUT.-CoLONEL CoNNOR: I might say that in any en-
rollment for military service the call is received from the
surgeon-general's office. The outside quota, which goes
into Red Cross civilian work in France and Italy and, it is
contemplated in Russia, is outside of military service. The
majority of the nurses the Red Cross is calling for now
will be used in the military and naval service.
Miss Clayton : We have taken other action as part
of the nursing program. We are starting a campaign for
nursing attendants. We are appointing committees to
look into the needs of the entire community, hospital need,
the sick in the homes, and in the public health field. We
believe we can use to better advantage the nurses we
have in every community. Most applicants for enrollment
have come from institutions; many are public health
workers or teachers, not nurses who are doing private
work among the wealthy. We believe that thousands of
nurses in private work can be relieved.
Dr. Huffman : Unlike some western schools, we have
felt no shortage of medical students. The prospects are
that next year's enrollment will be normal. But I feel
from my study of the situation and from what I hear that
there should be some definite program, in regard to the
medical student, on account of the legal preliminary re-
quirements before a medical student enters medical col-
lege, which in New York State are so explicit; something
will have to be done in a year or two to take care of those
who have not met these preliminary educational require-
ments, and who will be barred from the medical schools
either by the draft or because they cannot meet the pre-
liminary requirements.
As far as interns are concerned, it is difficult to foresee
what will happen. We have an intern enrolled, and
within the space of a few days he has entered the army,
or a small hospital has tempted him away with salary.
Mk. Downing: As far as the conservation of medical
students is concerned, there will be no trouble about that.
All the slackers who do not want to get into the army
are going into the medical schools and without any inten-
tion of becoming physicians. They told us from Washing-
ton not to speed up our medical schools. We found we
could speed up our four years' course. We saw what
was happening in spite of Washington saying we need not
do it. We foresaw they would take interns from our hos-
pitals and we would need graduates to take their place.
The fourth year has been successfully speeded up so that
men were made ready for the hospitals in February in-
stead of June.
About the nurses, that is more serious. They are not
taking Red Cross nurses out of the training schools; they
are taking them from private practice; but with 20,000
enrolled they have only used some — may I ask Dr. Gold-
water for the figures?
Dr. Goldwater: Twenty thousand enrolled, 11,000 to
12,000 in active service. The remaining 8,000 or 9,000
are not available; they are wholly or chiefly made up of
superintendents of training schools, assistant superin-
tendents, public health nurses, women rejected on physical
grounds, women acting as Red Cross instructors or doing
Red Cross committee work, women enrolled for limited
home service. There are few available army nursing re-
serves among them at present. The surgeon-general's
office is depending on future enrollments, and appears to
be confident that these will be timely and sufficient.
Mr. Downing: If there are thousands engaged in pri-
vate practice, if they are needed and there is no other
way to get them, they will have to be drafted. We must
THE MODERN HOSPITAL
39
also get a body of women toKether that will take care of
the civic sick who are convalescent and do not need a
trained nurse, and of the wounded men who are jroing to
come back. Some of them are back now. We must be
able to take care of the men that need trained service at
once. If the army training school will do it, all right.
But it seems to me the scheme to train these younfr women
in cantonments has some serious drawbacks. You can
found your training school in a cantonment, but where
will you get your supply? Who will go there? How long
will it take to train them? They will have a three-year
course. They will be fitted as trained nurses at the end
of three years. They will be available where? In the
cantonments only. There are about forty cantonments,
averaging 40,000 men, and 2,000 now sick in each can-
tonment. Two thousand sick will require 200 nurses.
Eight thousand women are needed in these forty canton-
ments. They will have to be women of the staunchest
character. I do not believe that the army training school
will meet the emergency as it exists today, nor am I in
favor of any short-course training school for triining
nurses. It is a great temptation to get training in a mili-
tary hospital; candidates will pass up the civilian hos-
pitals, and you will drain the nurses' schools of suitable
material.
We must not lose sight of the fact that we have a civil
population to be taken care of. When they take our
trained nurses out of the hospitals, we must have a few
good ones left as supervisors.
There are thousands of women in this town who want
to do something for their country. I say, give them a
chance. Here is one who can get away for three hours a
day from her home. Take her in the hospital and train
her. And when she is fit put her through an examination
on the knowledge necessary for taking care of the chronic
case of the convalescent. We will get a body of women
that will be trained and ready for an emergency.
Some day, pretty soon, instead of short lists of casual-
ties, we shall have two, three, ten thousand American sol-
diers wounded. The hospitals in France are full now.
They are asking for nurses. Many will have to be taken
care of here. We do not want to be caught three months
hence with no one to take care of them.
We must work out a plan by which the civilian sick
and those not badly hurt that just need a little nursing
can be cared for by those whom Dr. Goldwater calls "war
nursing aids." We can specify certain hospitals in this
country as those we will recognize as fit to do this work
of training women for nurses' aids. We want help during
the war. If there are any young women who want to
take this course now and go into nursing afterward, I
would give them credit for the work they have done
toward the three-year nursing period.
Mr. Bordex : It does not seem to me that the medical
profession volunteered in the army for the purpose of
teaching nurses, as it is proposed they shall do at these
army training schools. If the Medical Reserve Corps are to
devote their time to this, they might just as well be allowed
to remain in civilian life. Also, if trained nurses must
give their time to training these pupil nurses, they should
be allowed to do it in civilian hospitals. Who can say
how long these cantonment hospitals will be retained for
the training of these women? Suppose in one year the
war should be over, what will become of these training
schools? What promise can the army make to these
young women that they will have an opportunity in the
existing hospitals to complete their nursing education?
If they cannot promise this, they should not accept them.
It is only fair that pupils should have some assurance
that their training will be completed. Last week, at a
meeting of the Ohio Hospital Association, a paper was
read by a representative of the surgeon-general's depart-
train pupil nurses and war nursing aids so they can be
can do very little for the returned soldiers, but they can
ment. The final word was this, that the civil hospitals
used as required in the service of the government.
Dr. Howl.and: I think the future of these nurses is
the least consideration at the present time.
Dr. Warner: Has Miss Clayton any idea what pro-
portion of graduate nurses not in active duty are avail-
able for army work? Many graduates have husbands and
.small children, or physical incapacities; they are unthink-
able for even temporary work at home, to say nothing of
going ab'oad.
Miss Clayton : I cannot answer that question abso-
lutely. In our locality we consider that one-fourth of all
those we consider available for service could lay down
the work they are doing and go into military work.
Mr. Bunn: Has any thought been given to making use
of the senior pupils? We hope to be able to spare one-
half or more of our senior nurses, if necessity arises. I
would be willing to send one-half to the cantonments and
let them care for the soldiers.
Dr. Seabrook: When the call came for nurses our
state board of examiners made the suggestion to Wash-
ington that they should take the pupil nurses from the
three-year schools at the end of two years and they would
be eligible to go for war work in army hospitals under
supervision and at the end of three years would be eligible
for registration and diplomas would be granted.
Miss Greener: If we are to maintain our home hos-
pitals at standard efficiency, we cannot spare our third-
year pupils. In January, when our unit went out, we had
21 enrolled Red Cross nurses; 16 more were about to go
out with the unit, which left us only 16 graduate nurses.
There are no nurses in the country that can be brought
into the hospital to fill such vacancies; the only way to
replace graduate head nurses is to use third-year pupils.
We are confronted with another problem about enlarg-
ing the schools. We have plenty of applicants, but we
cannot get household help to take care of them and we
cannot ask them to do the work themselves. We can
hardly take care of the group of nurses we have at the
present time; so there is no inducement to take on more
pupils at present.
LiEUT.-CoLONEL HoRNSBY : I am sure that the secre-
tary will not permit and the army does not want to take
the pupil nurses in either the second or the third year
from the civil hospitals.
AFTERNOON SESSION
Dr. Goldwater: The hospitals will sooner or later be
called upon to treat handicapped soldiers. Relations will
doubtless be established with the federal agencies that are
to be responsibile for the rehabilitation of soldiers and sail-
ors. The vice-chairman of the Federal Vocational Board
will now address you.
Prof. Munroe: I speak absolutely unofficially as an
individual rather than as a member of the vocational
board. There is a bill before Congress in which sole re-
sponsibility for the soldiers and sailors after discharge
from hospital has been placed in the hands of the Board
of Vocational Education. This is to be brought up in the
House this week, but until that bill is passed the board
has nothing to do with this problem.
Nevertheless, the matter has been under discussion so
many months that we have made some study of this
problem. We have issued two bulletins, the first a study
based on former experience of the problem of vocational
rehabilitation of retraining the cripple in an old, or train-
ing him in a new, vocation after his physical rehabilita-
tion, and second, a study of preliminary vocational ther-
apy. Then we have in press a study of what has been
done in the allied countries. In addition, we have sent
twenty persons, men and women, specially competent for
this kind of work to study Canadian methods.
Furthermore, we have constantly, since early last fall,
been in conference with the surgeon-general's office on
certain aspects of vocational rehabilitation and the diffi-
culties that will arise in this proposed legislation in coop-
erative work between laymen like ourselves, dealing with
the vocational side of the man's training, and the medical
profession dealing with his physical rehabilitation.
The bill states that the surgeon-general's office has full
and absolute control over the medical and surgical reha-
bilitation and absolute military control over the man un-
til, in their opinion, he is fit for discharge from the hos-
pital. Then the Federal Board of Education takes charge
of him, in consultation with the War Risk Insurance
Bureau. The bill enjoins the surgeon-general's office to
call on us in an advisory capacity in the work of bedside
occupational therapy with its bearing on the future; and
our board is enjoined to call on the surgeon-general's office
for subsequent medical and surgical care which the man
may require, and on the Bureau of Labor to get the man
place.2 back in industry. We have been in constant com-
munication with the United States Chamber of Commerce
and various employers' liability organizations and the
.American Federation of Labor, our desire being on the
one hand not to upset the regular flow of industry and on
40
THE MODERN HOSPITAL
the other hand to see that the man is not exploited for
the selfish purpose of the industry.
The problem of the cooperation of the surgeon-general's
office and our board in the determination of what shall be
the bedside occupation before the man is discharged from
hospital is going to be a difficult one, and it cannot be
solved unless the two sides are willing to cooperate in the
friendliest way.
If you are going to reeducate a man vocationally and
put him back in society as a working unit, you must be-
gin from the moment he is brought back from the trenches
and put him in such a frame of mind that he will not only
desire to become an economic unit, but his mind will be
filled with the idea that it is his business to get well
trained as quickly as possible so he may go back and serve
his country from the standpoint of economy as well as he
has done from the military standpoint. That is largely a
question of psychology — never permitting him to think
he is broken, never allowing him to get hospitalized,
never permitting him to doubt but that he is just
as good a member of society as before his catas-
trophe. We believe that not only does this require
the proper attitude of mind on the part of the medi-
cal men and nurses, but that there must also be someone
whom we call a "vocational advisor," who is absolutely
familiar with all forms of vocations and who has the right
attitude of mind regarding the relation of the man toward
the vocation ; the vocational advisor must have oppor-
tunity to come in close contact with the patient and must
have cooperation from the physicians and nurses.
The plan would be for the Federal Board of Vocational
Education to have the right to put into every hospital
where these soldiers and sailors are taken a "vocational
advisor," who shall have free access to the medical rec-
ords, to the man himself, and who shall be in constant
consultation and touch with the surgeons and doctors and
educational men inside the hospital who are guiding his
vocational therapy. These three men, the surgeon in
charge, the director of educational therapy looking after
the hospital work, and the vocational advisor, these three
men before that crippled soldier leaves the hospital,
should have made up their minds within what range of
occupation the man is fitted. There are four or five hun-
dred occupations. If there should be established within
the hospital ten or twelve basic lines of occupation, wood-
work, iron, electrical, accounting in the higher education,
and a few more things like that, the hospital training can
be made very broad and at the same time can contribute
the occupational therapy, and when the man gets out of
the hospital he will have a broad basis on which the Fed-
eral Board of Vocational Education can, with the advice
of the doctor and the men in the hospital, decide what
special vocation out of 500 possible occupations he can be
trained for. That is the line of vocational training which
it would seem wise for the hospital to undertake. There
will be a temptation in certain hospitals to retain the
crippled man beyond the period when he is physically
rehabilitated in order to give him the necessary, from
their point of view, vocational training. It seems to me
this would be unwise. I am considering the ones who
never go back to the army but who will be civilians, and
the sooner they get out of the military atmosphere into
the civil atmosphere the better- The vocational director
going into the hospitals should be a civilian, for he will
better be able to keep before the crippled soldier the civi-
lian point of view.
There is a possibility we shall learn of wounded men
coming back in thousands and tens of thousands and subse-
quently, unless the surgeon-general's office has matured a
plan for sufficient beds, there is danger that many of them
will be turned out too soon because their room will be
needed. Consequently, it seems to me, there is a possi-
bility that the War Insurance Bureau will be obliged to
ask the cooperation of civil hospitals in helping solve this
problem of trying, at the same time, to carry on the final
physical rehabilitation and also the vocational rehabilita-
tion. If the military hospitals should be subjected to un-
expected pressure of men returning in large numbers from
the other side and forced to deal too early with this prob-
lem, then the question comes up, can the civil hospitals
take these men in the borderland period between too early
dismissal from army hospitals and the time when they
must take up their lives again and get back to industry,
complete their physical rehabilitation so we will not have
to take them half cured and try to make proper members
of society out of a physically sick man?
Dr. Rowland: I have been trying to find out just how
Boston is likely to be affected. The army has not yet used
the civil hospitals to any great extent, though a few cases
from the surrounding camps have been sent to us, but the
navy found itself inadequate to care for that section and
practically all the hospitals have been used to take care
of 25, 50, or 100 naval enlisted men. The thing that
bothers me is the outlook for taking care of returned sol-
diers. We are told the surgeon-general's office intends to
take care of them in large units in army hospitals, but
except for reconstruction hospitals I know of no attempt
to start or locate such hospitals in New England. It is a
vital question with us when every day some member of
the staff says, "May I go now?" What demands will be
made of us? We ought to know that so as to know what
to do with our staffs. I hope the matter of war risk in-
surance will be spoken of. As I understand it, there may
be enlisted men or officers of any branch, so there are com-
plications.
Mr. Borden : The question brought forward by Pro-
fessor Munroe is only one of the problems that have to
do with taking care of returned soldiers. The thing to
do is to urge that the hospitals receiving returned soldiers
should be located as near as possible to the place from
which the men originated. The .surgeon-general has agreed
to this, but up to the present time the declared policy of
the surgeon-general's office has not been followed. The
present needs of our hospitals from industrial accidents
are thirty-eight times what we may anticipate from mili-
tary ones, so the civil hospitals are interested primarily
in the first. The government has taken steps to solve the
problem of vocational therapy. It has been recognized
that the vocational rehabilitation should be in the line
the man followed before he went into the army, and, if
possible, in or near the place where he entered the army;
the place where he can best put his knowledge and train-
ing to use is in his own former neighborhood-
What about these occupational schools after the war?
If badly located in remote places, they will be of no use.
These schools should be established in big centers of popu-
lation. The place where occupational schools should be
is where the most people can be gathered, where there are
all forms of industry established, and where the men can
go right into the shops and factories as soon as they are
trained.
LiEUT.-CoLONEL HoRNSBY: I would like to answer Dr.
Howland. I am under orders now to go to New England
to look over the ground preparatory to the establishment
of another hospital in New England. We are now spend-
ing money to fix up the buildings at Plattsburg and after
the midsummer training camp is vacated it will be fixed
up for a zone hospital. I expect to confer with such
people as Dr. Howland and with the governor of Massa-
chusetts, who recommended a state appropriation to build
a hospital. In other words, we are alive to the necessity
of having another hospital in the New England district.
One hospital is ready now, and patients have already en-
tered in small numbers.
In regard to vocational training, it has been understood
fully that we would need a great deal of cooperation, and
I was under the impression that we had all agreed to
give it. I believe the surgeon-general's office has been
most generous in its attitude toward the opinion of others.
We can hardly get closer to the problem by assuming in
advance that someone is going to blunder.
May I go into this question of military hospitals? The
country has been divided into districts corresponding to
the draft districts. In New York, a port of embarkation,
we have 8,500 beds authorized already and shall have
in a few weeks in New York 11,000, in and about the port.
We are ready for that many here. These beds will be,
for some time to come, available for distribution- If we
get crowded at the port, we shall send the patients back
to the draft district from which they came. At Newport
News we are doing the same thing. Boston is not slated
to be a port of disembarkation, but if it becomes one we
shall have to take the matter of hospital beds into consid-
eration there. Philadelphia is in the same boat. I have
every belief that the desire of the surgeon-general's office
is to get the sick and wounded out of the way. We do not
want to be burdened with the care of people who are
getting back into civil life. The army should be reserved
THE MODERN HOSPITAL
41
for aggressive fighting and the rehabilitation and recon-
struction of the sick and wounded who are beyond mili-
tary service ought to be and will be a civil process in the
hands of civilian organizations and managed on civilian
principles.
Dr. Goldwater: A communication sent out by the Na-
tional Association for the Study and Prevention of Tuber-
culosis declares that under the requirements of the United
States Government all issues of bonds, stock, or other
capital required for the erection of new institutions or
additions to existing ones must be approved by the capital
issues committee of the Federal Reserve Board. The capi-
tal issues committee apparently will approve only of the
building of temporary wooden or other structures for hos-
pital purposes. They fully appreciate that this is not an
economical method in the long run, but for hospitals that
must be built now this is the only way that is allowable.
The association is preparing a set of designs for tubercu-
losis hospitals to conform with this ruling. What are the
general hospitals proposing to do about necessary building?
Dr. Ross: Since our countrv declared war, we have
spent over $400,000 in building, "nearly ?500,000. We are
expecting to start another building within three weeks.
The difference in cost of construction between the contract
in the fall of 1916 and one contract made last May was
only 1% cents per cubic foot. The contractors claim it is
just as advantageous now to construct buildings as it has
been for some time past and they have no idea that con-
struction is going to be cheaper. I can see no reason, if
those statements are true, why construction should not
go on at the present time. Plumbers, steamfitters, carpen-
ters, etc., are easy to obtain because building has largely
been shut off throughout the country. Only common labor
is in great demand. All our buildings are reinforced con-
crete instead of steel; it makes .iust as good a building
and the cost is considerably less than the steel.
Mr. Test: So far as Philadelphia is concerned, hospi-
tal construction is almost at a standstill because of the
present high cost of construction.
Dr. Goldwater: To maintain existing hospitals re-
newals are required. In order to maintain for the use
of the country at large the existing 800,000 beds, we must
have new construction at the rate of 20,000 to 25,000 beds
per annum, and provision should be made for such con-
struction if materials can be obtained.
Dr. Olson : In our state there is some hospital con-
struction going on. In Minneapolis there is a new build-
ing being opened, a Catholic hospital, which will accom-
modate 300 patients. The City Hospital is building an
addition for children which will have 800 beds. Another
one of the general hospitals is building a service building
at $35,000, and a new one is being built which will cost
$75,000. Duluth received a bequest of $600,000 for a
hospital and I believe intends to build it. It is a big
one and will be in the iron and steel district, where the
population has been increased, so that all sorts of build-
ings are required. Construction will proceed. In our
section labor is plentiful.
With respect to the location of army and navy hospitals,
I hope that when the War Department makes its plans
for these hospitals it will bear in mind the Central West.
In St. Paul and Minneapolis there is located an army
post which would provide an ideal location for a hospital-
We have a medical school at the University of Minnesota
and also a post-graduate school. We are very anxious
about the efficiency of these schools. So many medical
men have left that we are getting alarmed. We believe
that the location of an army hospital here would help in
keeping some of the good medical men home. We are anx-
ious to be of service to the nation by the training of
nurses. Hospitals have increased their schools and have
rented additional dormitories, and some could train mo'-e.
Dr. Goldwater called upon Dr. Peters to discuss the
labor crisis which is now seriously affecting hospitals
everywhere.
Dr. Peters: We have had troubles of our own, and it
is a question of settling the problem from day to day.
We are now advertising, but that is proving worth-
less as a way of securing people. We are substi-
tuting men for women and women for men. In our
service a grave problem is the intern situation. We
have lost a great many of our interns and today are
short practically one-third. We are training one college
woman for laboratory work, and nurses for ward work
and records. But a solution of the labor problem is out of
the question. When a munition factory is opened across the
street and offers three times the wages which we can afford
to pay, we are helpless. Wages in the cotton factories
have increa.sed 60 to 70 percent in two years. In addition,
there is no foreign labor coming into New England nowa-
days. We have factories and munition plants, and all
the industries are extremely busy, and private institu-
tions which must depend upon donations, do not know
what to do. And on top of this we are requested to do
work for the army and navy- The financial problem is
a very difficult one.
Dr. Seem : All classes of employees can obtain wages
with which we cannot begin to compete, and it is difficult
to get any new labor.
I5r. Howell: The orderly question is a serious one in
New York. The army, however, recently sent us twelve
enlisted men from .A.llentown to .serve as orderlies. They
remained si.x weeks and do very good work. I do not
know if other hospitals are so situated that they can use
them. These men had had no experience of this kind
before. There were two sergeants in charge of the men,
one with the night force and one with the day force. They
were put in the hospital wards as orderlies under the direc-
tion of our own orderlies. We assigned two men on part
time to the x-ray department and two to the laboratory.
Mr. Test : We have had some men from the Navy De-
partment and they gave very good service. We had some
of the orderlies from the base hospital for a few hours a
day; if the men from Allentown measure up to the navy
men, they must be satisfactory.
Dr. Goldwater: Is the American Red Cross in a posi-
tion to render assistance to civil hospitals in this country?
Lieut.-Colonel Connor: We have up to $225,000,000
available now. The object of the Red Cross is to care
for the unfortunate, whether by reason of military or
civil di.saster, and I can see no reason why that aid should
not be extended to civil as well as to military hospitals.
The funds of the Red Cross are being managed by men
of broad vision and no one has ever seen aid refused to
persons where there has been proved to be bona fide neces-
sity. The majority of the money so far has been spent
in France and Italy, but there is no reason to believe that
if the civil community needs aid from the Red Cross as a
war emergency that they will not get it. The money
donated now is needed for the war and that was the basic
argument in asking for subscriptions. If it is to be used
for any civil purpose, it must be demonstrated that it is
to help win the war. You have a strong argument, I am
sure, if properly presented.
Dr. Goldwater asked the conference to vote on the fol-
lowing resolution:
Resohfed, That the maintenance of the civil hospitals of the
country in a state of efficiency is a military necessity, and that the
attention of the American Red Cross be directed to the plight in which
the hospitals find themselves as a result of the actual shortage of
paid workers and in consequence of the inability of the hospitals to
secure labor in the face of the competition of the government and of
war industries.
The resolution was unanimously adopted.
Mr. Wright: In looking into the question of the reedu-
cation of the wounded soldier, one of the primary necessi-
ties is the training of the teacher, not from the vocational
end of it, but from the therapeutic end. In looking into
the statistics, we found that out of 38,000 soldiers re-
turned to Canada, 2,400 needed reeducation and voca-
tional training and the balance needed therapeutics. There
were facilities for training in the classroom, but a teacher,
in order to handle these soldiers, is in need of bedside
training, as the pupil nurse is in need of it ; facilities for
this did not exist. We got into touch with hospitals hav-
ing industrial accident cases and asked if they would
cooperate and there was a ready response. Private hos-
pitals in this city have from one to five such cases of in-
dustrial disability, ununited fractures, stiffened joints,
etc. — too few for any one hospital to organize a staff
for training. A central hospital is needed. We are finding
it difficult to raise funds except for soldiers. If the
sui jfeon-general's office could be induced to say they would
take such an institution over or place soldiers in it, there
would be no difficulty.
The draft is revealing a large amount of venereal dis-
42
THE MODERN HOSPITAL
eases and tuberculosis. These men, if not accepted in the
army, are turned back to society without any means for
following them up or seeing that these conditions are cor-
rected. It is going to be very unfortunate if we have all
this knowledge coming to us and we do nothing about it.
We have an organization in this state through whom we
get hold of tuberculosis cases and they are being cared
for, but there should be a government agency to see to
this throughout the country.
In the location of these reconstruction hospitals, I won-
der if due consideration has been given to the question of
locating them in or adjacent to the large manfacturing
centers. There are two reasons for doing this. In the
first place, the men could be sent from the hospital direct
to the manufacturing plant. It will be impossible to de-
vise a hospital machine shop of sufficient variety for the
things the men can do. But you will have a gi-eat variety
of factories available if the hospitals are located near a
large industrial center. There is another side to this.
There are many expert medical men who are able to give
a portion of their time, whose services would be exceed-
ingly valuable, but under the present regulations of the
surgeon-general's office they cannot be utilized. If the
hospitals were located within reach of them and the serv-
ices of these men could be utilized on part time, it would
be a wonderful addition to the service of the government.
Mr. Wright: There will be many men discharged from
the army for disability or for mental disease that existed
prior to enlistment. Something should be done about
these.
LlEUT.-CoLONEL HoRNSBY: There is no intention on
the part of the surgeon-general's office that helpless sol-
diers shall be sent back uncared for. Arrangements have
been made with state hospitals to care for mental cases
until other arrangements can be made.
Mr. Wright: I know the government has made ar-
rangements with state hospitals to care for insane sol-
diers. But I am speaking of instances where the condition
existed previous to enlistment. That being the case, the
army discharges the man and does not recognize any re-
sponsibility for him. At least the National Committee of
Mental Hygiene have been so informed.
LlEUT.-CoLONEL HoRNSBY: The War Department has
ruled that a man having been accepted in the army and
haying become a soldier, is entitled to all the rights and
privileges of a soldier; the government does not expect
to evade the care of any man subsequent to his enlistment
merely because he acquired something before he entered;
the army assumes all responsibility for him at enlistment
and the government must assume responsibility for his
care if he becomes incapacitated afterward.
THE WAR AND INTERNS IN SPECIAL HOSPITALS
General Hospitals Should Give First Choice to Young Men
Physically Qualified for Army Service
For two reasons the Department of the Surgeon-General
of the Army has signified its desire to promote the educa-
tion of interns in proper hospitals for as long a period as
the exigencies of war will permit: primarily, that the
future military surgeon may begin his medical career
with as much professional experience as possible; second-
arily, so that the organization of hospitals for civilian
treatment and for instruction of physicians and nurses
may not be unnecessarily disrupted.
How far do these consideiations apply to certain special
hospitals, such as hospitals for women, children, consump-
tives, eye and ear cases, and insane, and what should be
the policy of the army with regard to interns in such
institutions ?
It seems clear that thorough education in all types of
cases treated in the foregoing, except maternity and chil-
drens' hospitals, will have definite value for militai'y pur-
poses and that the same policy with regard to interns in
these should be followed as in general hospitals. Prob-
ably the childrens' hospitals may be placed in the same
category as the others, as the medical and surgical experi-
ence gained therein is such 'as to afford a substantial
foundation for military service, and this, taken into con-
sideration with the desire to preserve the hospital organ-
ization, should warrant the placing of childrens' hospitals
on the same basis as general hospitals so far as intern
service is concerned.
With hospitals for women the situation is very different.
Service therein is intensive in a branch of medical science
which has no direct relation to military needs and, there-
fore, such hospitals can not receive the same consideration
as other hospitals as places of preparation for military
service.
On the other hand, it would seem that in such hospitals
the organizations could be properly maintained by the aid
of personnel not fitted for army service. Not every
medical student is eligible for active military service of
the kind to be anticipated and desired by the young
medical man who has at last reached the place in his
career where he can be of great value to the country.
General hospitals should give first choice to those who
are physically fit for the work in the army and navy, while
young men who are not physically handicapped should like-
wise seek internships in hospitals where they can obtain
the best possible training for military service. Those who,
by reason of physical disqualifications, are not entitled to
enter the country's service in its military branches should
welcome the opportunity to aid in its general efficiency by
engaging in other work essential to welfare.
Thus, by cooperation between hospitals and between hos-
pitals and student, can we come nearer a solution of the
tremendous problem of making the supply of medical men
meet the requirements of war.
With the use of women physicians and medical students,
and the proper allotment of student interns to places where
they can be of the greatest use according to their qualifica-
tions, it would seem that an obvious difficulty may be at
least minimized, and the authorities in medical schools can
aid materially in advising their young men as to the proper
course to pursue. Some men who have a special interest
in obstetrics and gynecology may dislike to abandon the
opportunity to specialize in such bra;iches during the
period of their internship, and surely the country cannot
afford to be vwthout the service of men so especially edu-
cated, but the needs of our fighting men are immediate
and imperative, and our young men vnll no doubt be will-
ing to sacrifice their personal ambitions for a time as
many of the older men of the profession have already done.
The foregoing is the result of interviews with officers
of the Surgeon General's Department by a i-epresentative
of the American Hospital Association. It has been sub-
mitted to them and is believed to fairly represent the
policy of the department with regard to interns in special
hospitals.
Hospitals at home and abroad are threatened with a
famine, seemingly trivial but in reality one that may cause
considerable suffering — the palmleaf fan famine. A recent
press item says: "One of the lines of export between
Hongkong and this country temporarily destroyed by high
freight rates and the high exchange value of silver is
that of palmleaf fans. The common fans are simply the
trimmed leaf and stem of the ordinary small palm which
grows wild in most districts of south China. When culti-
vated or grown the palms are thickly sown, varying accord-
ing to methods followed, from 5,000 to 10,000 plants to an
acre, the fewer the plants the better the quality of leaf.
About seven years is required for the palms to grow to the
size necessary for a good fan."
THE MODERN HOSPITAL
43
A TIMELY AND SIGNIFICANT MEETING
Fourth Annual Convention of Ohio Hospital Association,
Columbus, Distinpruished by Earnestness and
Patriotic Spirit
The Ohio Hospital Association met at the Hotel Deshler
in Columbus, Ohio, May 28 and 29. The meeting was
a significant one and decidedly characteristic of the
times. The papers and discussions followed each other
on time. Useless politics and useless arguments were
absent. Some of the papers appear in this number of
The Modern Hospital; others will be published in early
issues.
Mr. T. S. Bunn, superintendent of the Youngstown Hos-
pital, presided in a way that seemed to get everybody
down to necessary business, and the program and com-
mittee meetings, which were expected to take up the best
part of three days, were finished in two, and finished well.
The keynote of the meeting was service. The papers
in the main were about questions pertaining to serious
problems which we must meet as war needs and meet as
soon as possible.
The hospital men and women who attended the meeting
were serious. They forgot themselves, their own point of
view, and the self-interest of their particular hospital in
the general need for team-work. The most frequent ques-
tion asked was: "What does the govei'nment want us to
do, and how can we do it?" They seemed to realize that
public meetings have no right to use transportation facili-
ties unless they met in this spirit. The Ohio meeting was
a lesson in conservation and patriotism.
Mr. Bunn's opening address sounded the keynote of the
meeting. The hospitals, he said, must readjust themselves
to war needs, and must not make excuses for failure be-
cause interns and nurses, domestic labor or hospital and
food supplies have to be readjusted or conserved. Mr.
Bunn dwelt upon the necessity of conserving time and
labor of physicians and nurses, the duty of the hospitals
to train nurses as fast as possible, and to take the respon-
sibility for civilian relief wherever possible. Mr. Bunn's
closing sentence was indicative of the spirit of the Ohio
meeting: "This is the time when personalities count only
as they contribute to the cause to which every redblooded
man and woman should be dedicated in these days of the
world's travail."
The report of the secretary. Dr. E. R. Crew of the
Miami Valley Hospital, Dayton, was confined to a very
brief reference to the printed report.
Miss Belle Sherwin, of the woman's committee of the
State Council of Defense, told of the work of the women's
organizations of the state, through the woman's commit-
tee, to increase the membership in the training schools and
to cooperate with the hospitals and nursing organizations
in increasing the present number and future supply of
nurses for national service. Miss Sherwin's talk was
con.servative and showed a splendid attitude in the lay
women of Ohio in this work. The educational value of
the work done was immeasurable; the actual results were
gratifying.
Miss Florence Dakin, superintendent of the Middletown
Hospital, gave an interesting paper on trained attendants,
DR. .\. R. \V.\RXER,
PRESIDENT OHIO HOSPITAL ASSOCIATION,
Superintendent Lakeside Hospital, Cleveland, Ohi<
DR. E. R. CREW,
SECRETARY-TREASURER OHIO HOSPITAL ASSOCIATION,
Superintendent Miami Valley Hospital, Dayton, Ohio.
an important subject in these days when we must con-
serve .;ar interns and nurses.
Mr. John G. Bowman, who was to have read a paper
on "The Present Status of Hospital Standardization," was
unable to be present. The Rev. Father Moulinier, who
44
THE MODERN HOSPITAL
Members of the Ohio Hospital Association, assembled at Columbus for the fourth
had planned to represent Mr. Bowman in his absence, was
detained by illness in New York, and was unable to attend
the meeting; Mr. F. E. Chapman, superintendent of
Mount Sinai Hospital, Cleveland, who has been doing some
special work for the American College of Surgeons, gave
a short talk on the college requirements for classification.
The paper read by Mr. John C. Lapp, director of in-
vestigation of the Ohio State Health and Old Age Insur-
ance Commission showed that the commission had put
much intelligent study on the question of health insurance
and that whatever conclusions they may reach, will be
reached through a sane and humane attitude toward this,
one of our most valuable "lessons from the enemy."
The early part of the Wednesday morning session was
taken up by the round-table conference on war economics
led by Mr. Bunn.
The first papers of the session took up conservation in
the dietetic department of the hospitals. Miss Sarah
Benedict, dietitian of the Miami Valley Hospital, Dayton,
and Miss Bertha Beecher, of Christ Hospital, told of the
way in which these hospitals are observing the regulations
of the Food Administration and conserving wheat, meat,
and sugar.
Miss Nell Stilt, of Lakeside Hospital, Cleveland, de-
scribed how this hospital has saved materially in the use
of gauze, and told the method of gathering, laundering,
and sterilizing it for further use. Miss Stilt's paper ap-
pears in the War-Time Institution Economies Department,
this issue.
Two excellent papers were read on hospital housekeep-
ing problems, one by Miss Mary A. Jamison, superin-
tendent of Grant Hospital, Columbus, and one by Miss
C. L. Butterfield of Martin's Ferry, Ohio. These two
papers gave the viewpoint and the problems of both the
large and the small hospitals and the way in which the
present shortage of labor and material is met in their
institutions. Miss Jamison's paper is published in this
issue.
Dr. A. R. Warner, superintendent of Lakeside Hospital,
Cleveland, gave a very practical talk on laundry conser-
vation, the use of proper machinery, and the system used
at Lakeside which has saved and conserved their linen
supply since it was put into use.
Mr. Frank E. Chapman's paper on the conservation of
light and fuel was published in our June number.
Dr. T. R. Fletcher, acting chief medical examiner of
the Industrial Commission of Ohio, read an interesting
paper on the work of his commission and in the discussion
which followed answered questions from the floor asked
by hospital administrators who have been endeavoring
to come to a harmonious working basis with the commis-
sion.
Senator Howell Wright's paper was on the relations
of hospitals to the state. This paper covered comprehen-
sively the question of the authority of the state in the
matter of inspection, licensing, and supervision of hos-
pitals, and also something of the desired legislation on
this matter.
A banquet was given in the hotel ballroom for the
evening session. Mr. Richard P. Borden, secretary of the
war service committee of the American Hospital Associa-
tion, talked to the members of the association on the serv-
ice of the civil hospital at the present time to do its share
for a nation.
This last paper was given and heard by the audience
in serious mood. Its lesson was this. Although the
civil hospital can do very little directly at the present
time for the returned soldier, there are two things of
great value, things of absolute need for the care and
morale of our men that they can do: first, to ti-ain nurses,
and more nurses, and then more nurses; second, to provide
civilian relief, to keep up the courage of the man in uni-
form by caring for those he has left behind. In this way
the hospitals of this country, and those of us in them who
for some reason or other must stay behind, can keep up
the supply of trained women to care for the sick and
wounded, and to help the recovery of those sick and
wounded with the knowledge that mothers and fathers,
wives and children are cared for while they fight for us.
The following officers of the Ohio Hospital Association
were elected for the coming year: president. Dr. A. R.
Warner, Lakeside Hospital, Cleveland, Ohio; secretary
and treasurer. Dr. E. R. Crew, Miami Valley Hospital,
Dayton, Ohio; first vice-president. Father M. F. Griffin,
St. Elizabeth Hospital, Youngstown, Ohio; second vice-
president. Miss Alice Thatcher, Christ Hospital, Cincin-
nati, Ohio; third vice-president. Miss Mary Jamison,
Grant Hospital, Columbus, Ohio; executive committee,
Mr. F. S. Bunn, Youngstown Hospital, Youngstown, Ohio;
Mr. P. E. Behrens, Toledo Hospital, Toledo, Ohio; Miss
Marie E. Lawson, City Hospital, Akron, Ohio; Mr. F. E.
Chapman, Mount Sinai Hospital, Cleveland, Ohio.
THE MODERN HOSPITAL
45
VOCATIONAL THERAPY IN MENTAL HOSPITALS
The Annual Meeting and Exhibit of the American Medico-
Psychological Association in ChicaRo — Artistic
Quality of Products Made by Patients
The seventy-fourth annual meeting of the American
Medico-Psychological Association was held at the Hotel
La Salle in Chicago from June 4 to 7. The meeting was
well attended and an interesting program of papers was
presented. The discussion of the diagnosis and treatment
of mental and nervous diseases and reeducational methods
which have taken the place of custodial care made this
meeting one of peculiar interest at this time, when every-
thing which touches on the reconstruction of the disabled
soldier and civilian war victim is of such vital importance.
Dr. H. G. Gahagan, who has made a special study of
diversional occupation in his work at the state hospital
in Elgin, 111., was in charge of the exhibit. An unusually
good display of handicraft was shown, representing 13
New York hospitals, 5 in Illinois, 2 in Canada, 1 in Maine,
5 in Massachusetts, 2 in the Carolinas, 1 in Utah, 1 in
Tennessee, and 2 in California.
Fig. 1. Class in knitting at Binghamton State Hospital, Binghamton,
N. Y. These patients are of a ven' low-grade type, who have be-
come interested in work for the army and the Red Cross.
New York state exhibits were carefully classified and
represented considerable work and study on the part of
the chairman of the exhibit. Dr. H. M. Pollock, statistician
of the New Y'ork State Hospital Commission. Wall charts
and photographs were shown of patients suffering from
various forms of psychosis who had made a definite im-
provement under diversional occupational treatment. Pho-
tographs illustrated the value of physical culture exer-
cises and various drills. Accurately made baskets, clev-
erly made lace and embroidery, leather and metal work
and plaster bas-reliefs, all the work of patients, were ex-
hibited and one New Y'ork hospital showed a large paint-
ing, made by a manic-depressive from a small print of
the well-known painting showing Philippe Pinel striking
the fetters from the demented patients of the Salpetriere.
The Anna Steele Hospital, Anna, 111., showed some
especially well-made embroideries on linen and beauti-
fully crocheted filet lace. One strange and interesting
specim.en of this exhibit, the spontaneous work of a
young negro woman in whom dementia precox developed
following the race riots in East St. Louis, was a pair of
white stockings, embroidered in ravelings from her black
stockings and a red table-cloth. The designs were a
liighly conventionalized black cat on one stocking and a
seven-branched candlestick on the other, both surrounded
by an elaborate medley of black and red dots.
Watertown, III., had a splendid industrial exhibit —
men's tailored clothes, caps made from scraps of cloth,
uniforms and dresses for various attendants and work-
ers, brooms and cement work, all made in miniature, all
Fig. 2. Group of specimens of copper work, weaving, toys, basketry,
and pottery made by patients in Danvers State Hospital. Danvers,
Mass. The artistic quality and grade of workmanship in this ex-
hibit are very high.
showing work of good economic value as well as of value
in mental reeducation.
A Utah hospital showed accurate work in brush-making
and basketry.
The Bangor, Me., hospital had some characteristic
sailor and ship's carpenter handiwork, including a model
of a rigged ship and log houses, and ship's chains and
mallets hand-carved from wood.
The California exhibit was typical, too. The clay mod-
els and baskets savored of the early Spanish missions.
Fig.
Pottery cla
rs State Hospital,
of the produc
The exhibit of the Massachusetts hospitals was plainly
indicative of the advance in arts and crafts made in that
state. In the Danvers exhibit there were unusual ex-
amples of dull and glazed pottery, most artistic metal
woik, rugs that have a high commercial value because of
their original designs, beautiful coloring, and accurate
weave, and baskets that could take their place with pride
on the shelves of an exclusive Fifth Avenue shop. One
vase of American Indian design had been eight months
in the making by a patient who had worked at it for four
46
THE MODERN HOSPITAL
hours a day. Taunton Hospital showed very good ex-
amples of pottery and metal work, and some artistic rugs.
The most unique feature of the whole exhibit was Mrs.
Peggy Ann Sutton's quilt. This quilt is of the large old-
fashioned bed size. It is backed with and quilted through
white muslin and pieces of white ribbed underwear of
various sizes and bordered with black cloth. The back-
ground is of solid embroidery of a buttonhole stitch in
white embroidery cotton, and the whole thing is covered
with figures of people, flowers, and animals, worked in
ravelings from black and white and various colored cloth
obtained wherever Mrs. Peggy Ann could get them. The
figures represent relatives, friends, visitors, and em-
ployees of the hospital, and her friends in the farm and
barnyard and garden. There are men, women, and chil-
dren, young and old, thin and fat. Their clothing varies
from high hats to farm hats and from shawls to present-
day fashions in women's dresses and suits. The quilt is
entirely the spontaneous, undirected work of this patient,
a manic-depressive, 63 years old, of eleven years' resi-
dence in the Central Hosiptal for the Insane at Nashville,
Tenn.
Treatment of mental disease in state hospitals has
certainly made rapid strides in the last few years. Cards
attached to handiwork in this exhibit show case after case
history of patients who have shown decided improvement
with diversional occupation therapy.
The following officers of the American Medico-Psycho-
logical Association were elected for the coming year:
president, Dr. E. E. Southard, physician in charge of the
Boston State Psychopathic Hosiptal; vice-president, Dr.
Henry E. Eyman, superintendent of the Massillon State
Hospital, Massillon, Ohio; secretary-treasurer. Dr. H. W.
Mitchell, superintendent of the State Hospital for the In-
sane, Warren, Pa.
Combined Meeting of the Canadian National Association
of Trained Nurses and of the Canadian Asso-
ciation of Nursing Education
The annual meeting of the Canadian National Associa-
tion of Trained Nurses was held in Toronto, June 4 to
June 8, in conjunction ■with the meeting of the Canadian
Association of Nursing. A joint meeting of the two organ-
izations was held the first two days of the convention.
The morning of June 6 was taken up by the reports of the
president, the secretary, the treasurer, the standing and
special committees, the affiliated organizations, and the
Canadian Ntirse.
The following papers were presented at the afternoon
session: "Public Health Nursing in Manitoba," by Eliza-
beth Russel, superintendent of Provincial Public Health
Nurses; "Public Health Nursing in Alberta," by Christine
Campbell, superintendent of The Royal Alexandria Hos-
pital, Edmonton; "Halifax Disaster and the Relief Work
Done," by Miss Pickles, superintendent of nurses, Victoria
General Hospital, Halifax; "The Infant Soldier," by Dr.
W. W. Chipman, professor of gynecology and obstetrics
of McGill University, Montreal; and "The Work of the
V. A. D.," by Mrs. Henderson of Montreal.
At the business sessions held Friday and Saturday morn-
ings, the subjects discussed were: plans for the Canadian
Nt<rse for the ensuing year; the great shortage of gradu-
ate nurses throughout the Dominion and how to meet this
national need; and the adoption of a new constitution and
by-laws. Friday afternoon the delegates visited Hart
House and the Davisville Orthopedic Military Hosiptal.
In the evening a joint session was held with the Canadian
Association of Nursing Education, at which two addresses,
followed by general discussion, were delivered, one, "Nurse
Education," by Adelaide Nutting, Teacher's College, Colum-
bia University, New York, and the other, "Introduction
of Nurse Education in Canadian Universities," by Dr.
Helen MacMurehy of Toronto. Elizabeth Robinson Scovil,
of Gagetown, New Biunswick, read a paper on "The Duty
of a Nurse to Her Nursing Journal."
REHABILITATING THE TUBERCULOUS SOLDIER
AND WORKER
Important Subjects Discussed at the Fourteenth Annual
Meeting of the National Tuberculosis Association
The fourteenth annual meeting of the National Tuber-
culosis Association (until recently the National Asso-
ciation for the Relief and Prevention of Tuberculosis)
was held on June 6 to 8 at the Copley Plaza Hotel, Bos-
ton. Prominent physicians and lay workers from almost
every part of the United States were in attendance.
After the address of welcome to the city by the Hon.
Andrew J. Peters, mayor of Boston, and the address of
the president, Dr. Charles L. Minor, Dr. Charles J. Hat-
field, the executive secretary of the association, read a
report of the year's work. Through the office of the
Surgeon General of the Army, he said, all men discharged
from the army because of tuberculosis and those rejected
by the examining boards are reported to the National
Tuberculosis Association and through that body are
brought in touch with facilities for adequate care and
control in their own community, including antituberculo-
sis agencies, boards of health, and the Red Cross, and
every effort is made to see that each man is properly pro-
vided with sanatorium or home care and that his family
does not suffer want. Thus far 11,000 soldiers have thus
been reported and the system will be extended to cover
every tuberculous soldier as long as the war lasts. Dr.
Hatfield stated that the estimates previously made by the
association, that at least 2 percent of the 10,000,000 men
called in the first draft would be found on complete physi-
cal examination to have tuberculosis, have not been over-
stated.
The Red Cross Seal sale last year for tuberculosis work
in this country yielded $1,750,000. Plans are being made
for a campaign to raise $3,000,000 this year.
Nearly 700,000 children have been enrolled in the Mod-
ern Health Crusader movement, and under the direction
of competent leaders are being taught how to care for
their own bodies and how to protect the health of their
own communities.
Thursday evening, under the chairmanship of Dr.
George Thomas Palmer, of Springfield, 111., was devoted
to a discussion of tuberculosis as related to the war. Dr.
James Alexander Miller of New York City read a paper
on "How America is Helping France with Its Tubercu-
losis Problem." He reviewed at some length the work
that has been done in France by the Commission on the
Prevention of Tuberculosis, which is being supported by
the Rockefeller Foundation, and of which Dr. Livingston
Farrand, president of the University of Colorado, is the
head. The commission is working in close cooperation
with the French Government and the American Red
Cross. Its aim is to show the French people how Amer-
ica is fighting to control the Great White Plague. Among
the methods employed are special demonstrations by dis-
pensaries, nurses, sanatoriums and hospitals in Paris
and in one of the rural departments. Lectures, exhibits.
THE MODERN HOSPITAL
47
and other public meetings are being held in various parts
of France. They are attended by thousands and the
whole country is awakening to the fact that tuberculosis
is a serious menace and that the American efforts to
arouse community responsibility in the control of this
disease may well be copied in France.
Col. George E. Bushnell, M.D., who is in charge of the
tuberculosis division of the Surgeon General's Office, read
a paper on "How the United States is Meeting the War
Problem." Dr. Bushnell described the remarkable ex-
pansion of the personnel of the Surgeon General's Office
made necessary by the war, the care which is being taken
to weed out the tuberculous from the ranks and their
subsequent care and treatment. He stated that the army
now had at various points in the country 5,875 beds for
use in the care and treatment of soldiers suffering from
tuberculosis.
"How Canada is Meeting the Tuberculosis War Prob-
lem" was the subject of a paper by Capt. Jabez H. Elliott
of Toronto, Canada. One of the interesting points he
brought out was that the incidence of tuberculosis in
the Canadian army had been less than that of the male
civil population of military age. He urged the desirability
of a scheme of graduated work among the patients at
sanatoriums for both therapeutic and disciplinary reasons.
Friday morning and afternoon and Saturday morning
were devoted to clinical, sociological, and pathological sec-
tion meetings. The clinical section meetings were pre-
sided over by Dr. Walter R. Steiner, Hartford, Conn.;
the sociological, by Mr. James Minnick, Chicago; and
the Pathological, by Dr. M. C. Winternitz, New Haven,
Conn. Papers read in the clinical section of special in-
terest to hospital executives were a paper by Dr. J. A. Rut-
ledge of Woodmen, Colo., on "Thirty-five Hundred Cases
of Tuberculosis Which Have Been Treated at the Modern
Woodmen Sanatorium for Tuberculosis," and one by Dr.
J. Dworetzky on "The Institutional Care of Laryngo-
Pulmonary Tuberculosis." In an interesting address en-
titled "Methuselah and Life in the Open," Dr. Vincent
Y. Bowditch of Boston, deprecated the expensive sys-
tems of ventilation installed in many public buildings
and extolled the simple devices used in open-air schools
and sanatoriums for the treatment of tuberculosis as
not only much cheaper but vastly more efficient.
The papers in the sociological section bristled with in-
terest to workers in the hospital and social service fields.
Dr. C. A. Prosser, secretary of the Federal Board for
Vocational Education, Washington, spoke on the problems
in the vocational reeducation of disabled men. He stated
that figures compiled from the average of all belligerents
show that for every 1,000,000 men mobilized, 10,000, or
1 percent of them each year, would be proper subjects for
vocational retraining. On the basis of an army of 5,000,000
men, we would have 50,000 men each year who would need
assistance and help in the restoration and increase of
their earning capacity under the various classes of dis-
ability incurred. "Of the 10,000 men out of the million,"
Dr. Prosser continued, "fully 50 percent will require
medical rather than surgical care — men who have devel-
oped tuberculosis, heart trouble, kidney trouble and func-
tional disorders. The other half of the 10.000 must have
some sort of surgical attention. Of the 5,000 surgical
cases, there will, as the average shows us, be 10 percent
in dismemberment cases where there has been a leg or an
arm lost; and of these 500 men, 300 will have lost legs
and 200 will have lost one or both arms. The figures
show an astonishingly small percentage of blindness. Out
of the 41,000 men returned to Canada, there were only
27 blind men.
"A study of these and other figures carries the convic-
tion that this problem is by no means wholly that of
the crippled or the maimed. It is the problem of the man
who has a complication of troubles or injuries that, while
surgical, do not amount to dismemberment; such, as for
instance, as a man with the muscle of an arm shot away,
causing him to lose the use of the arm.
"With such a diversity of injuries, being largely indi-
vidual, so to speak, the work of reeducating these men be-
comes one which cannot be dealt with along broad, gen-
eral lines, but each man will require individual treatment,
individual study of his case, individual training and in-
dividual effort on his behalf in placement after he has
been reequipped to take up the broken threads of civilian
life."
Lieut.-Col. Harry E. Mock, M.R.C., Washington, D. C,
could not be present at the meeting, and his paper on
"Reconstruction and Rehabilitation Work for the Tuber-
culous in the Army" was read by Dr. Palmer of Spring-
field, 111. Dr. Mock said that the soldier disabled by
tuberculosis should be restored to complete physical use-
fulness just as well as one who has had his leg shot off.
In reclaiming those in military service who have con-
tracted tuberculosis and in securing their complete re-
habilitation, a policy similar to that which has been
worked out before the war in reclaiming men found to
be unfit by medical examination in industry is being em-
ployed. Instead of allowing these patients to lie around
sanatoriums doing nothing except reading and playing
cards and becoming generally hospitalized, it is planned
to start their rehabilitation during this period when their
physical reconstruction is taking place. Patients in bed
or in wheel-chairs will be taught certain useful trades
or occupations. When discharged, if it is necessary, these
men will be placed in special vocational schools where they
will either be taught a new trade or made more proficient
in their old one. The Surgeon General plans to keep
close supervision over every tuberculous soldier until he
is fully reclaimed.
Every soldier discharged from the army because of
tuberculosis will be entitled to the following lines of
treatment in an effort to reclaim him as a useful citizen :
(a) the best medical treatment with certain adjuncts to
secure the most rapid recovery; (b) certain occupations
in connection with this treatment to prevent hospitaliza-
tion and to refit for employment; (c) suitable employment
after the disease is arrested or apparently cui-ed, combined
with proper medical, social, and economic supervision.
Practically every address at the Friday afternoon and
Saturday morning sessions of the Sociological Section was
devoted to some phase of employment as related to the
tuberculous, whether on the farm, in an industrial colony,
or in a factory. Dr. Martin F. Sloan, Towson, Md., de-
livered an address on "Farm Work for Tuberculous Pa-
tients at Eudowood Sanatorium." This farm colony was
established in the spring of 1908. Its purpose was to
take men and women in different stages of the disease
whose lesions had become arrested and whose symptoms
had been reduced to a minimum, perhaps a chronic cough,
expectoration and shortness of breath, but whose sputum-
in most cases remained more or less positive and to give
them supplementary treatment. Its idea was not prima-
rily to convert a city man into a farmer or to help irr
back to the country movement. It has not been conducted
with the Utopian and impracticable idea of converting
c." sumptives into agriculturists. The colony during the
ten years of its existence has cared for almost two hun-
dred cases in practically all stages of the disease but in
48
THE MODERN HOSPITAL
whom the lesions were quiescent. The work has consisted
of raising poultry, swine, rabbits, sheep, and pigeons;
trucking and canning; fruit and berry-raising; and, in
some few cases, heavy field work. The physical results
accruing to the patients have been in the main encour-
aging. Careful bookkeeping shows that as an economic
measure this farm work system pays. The speaker sug-
gested that, since the Federal Government will have a
large number of tuberculous soldiers to care for, it would
be well to look into the scheme with the thought of using
its principles in caring for its tuberculous soldiers.
Dr. Bayard T. Crane, Rutland, Mass., read a paper on
"The Training of the Sanatorium Patient in an Industrial
Colony," in which he described the work now being devel-
oped in the hills surrounding Rutland, where a demonstra-
tion is being made of the economic value of the labor of
convalescent tuberculosis patients. The work is both in
agriculture and in the handicrafts.
Capt. J. R. Byers of the Canadian Army Medical Corps
dealt with the problem of the returned tuberculous soldier
in Canada. Here are two or three illuminating quotations
:from his address. "When I was called upon in 1916 to
direct the treatment of some of Canada's returned tuber-
cular soldiers, I found that on account of the excitement,
danger, and adventure of their life at the front, these
men were not only indifferent to ordinary methods of
treatment but openly rebellious against such methods.
Thirty-three percent of those received at the sanatorium
of Ste. Agathe des Monts, Quebec, during the first six
months refused to remain and 15 percent had to be dis-
charged for open insubordination. Concluding, therefore,
that these ordinary methods simply increased the soldier-
patients' irritation, I recommended to the military hos-
pital authorities a new mode of treatment along voca-
tional lines. This recommendation was adopted, and the
results have been much better.
"As compared with the general apathy under the old
.system there has been great enthusiasm under the new
regime. Insubordination has been reduced to less than 2
percent, and instead of refusal of treatment, there have
been applications for extension of treatment to pei-mit
courses to be completed. Mental and moral conditions
have been improved to a surprising degree. Each man's
mind has been pleasantly occupied, his nervous system
soothed, and his mental powers enhanced. While thus
far no great percentage of men have been given a com-
plete industrial training, a fair proportion have been
fitted for civil service positions.
These results have convinced the Canadian Government
of the benefit of the plan, which has now been extended to
every hospital in Canada under the Department of Civil
Reestablishment.
One of the most interesting and stimulating papers of
the meeting was Mr. Edward Hochhauser's paper on
"Three Years' Experience in the Employment of the Dis-
charged Tuberculous Patients in Factory Work." Mr.
Hochhauser contended that institutional care is incom-
plete and wasteful if patients are constantly relapsing.
"In the final analysis the real test of effective care of
the tuberculous is the return of the patient to economic
usefulness and if possible a condition of self-support."
Among the discharged patients placed at work by the
Committee for the Care of the Jewish Tuberculous in
their factory under medical and nursing supervision,
the relapses have been reduced from 50 percent to 80
percent. The patients may be said to spend a period of
industrial convalescence in the factory. The experiment,
which has proved successful, wa.s tried only after it was
found that suitable employment could not be found for
the patients in ordinary factories. As only negative
sputum patients are taken, the factory is primarily not
a medical proposition but an economic undertaking. Mr.
Hochhauser finds that the opportunity afforded to earn
better wages than was otherwise possible, while also mak-
ing progress back to health, proved a general stimulus
and rehabilitated many individuals and families. The
saving in relief in the case of those who formerly
required charitable assistance has been far in excess of
the cost of conducting the factory, and the families have
had considerably more than they would have had if they
had continued as relief cases. The saving in health and
in relief would have justified the experiment even if at
the end of three years our resources consisted solely of
the equipment at the factory. As a matter of fact the
factory has been entirely self-supporting for the last sev-
enteen months and its resources as reported by certified
accountants are equal to the amount advanced by the Com-
mittee for the Jewish Tuberculous. The experiment was
described by Mr. Hochhauser in The Modern Hospital
(March, 1917, p. 207).
The latter half of Saturday morning was devoted to
a discussion of the Framingham Health Demonstration,
which is being conducted by the National Tuberculosis
Association under the direction of Dr. Donald B. Arm-
strong. Dr. Aimstrong reviewed the first year's results.
Dr. P. C. Bartlett spoke on the consultation and medical
examination work, while Miss Mary A. Abel covered the
educational and organization activities. Many of the
delegates spent the afternoon at Framingham, where the
staff of the Community Health and Tuberculosis Demon-
stration held open house.
The following officers of the association were elected:
president. Dr. D. R. Lyman, Wallingford, Conn.; honorary
vice-president. Col. George E. Bushnell, U. S. A.; vice-
presidents. Dr. Lawrason Brown, Saranac Lake; Dr. Lee
K. Frankel, New York; secretary. Dr. Henry Barton
Jacobs, Baltimore; treasurer, William H. Baldwin, Wash-
ington, D. C. ; executive committee, W. Frank Persons,
Washington, D. C; Dr. 0. O. McMichael, Chicago; Dr.
Charles L. Minor, Asheville, N. C; Dr. H. E. Dearholt,
Milwaukee, Wis.; Dr. Fred L. Hoffman, Newark, N. J.;
Dr. E. R. Baldwin, Saranac Lake, N. Y.
Resolutions were passed pledging the support of the
National Tuberculosis Association to the directors of the
Army Medical Museum in their efforts to secure appropri-
ations from Congress for a new building and new equip-
men and for the expansion of the museum to make it
eventually a center for medical teaching and research;
requesting that Surgeon-General Gorgas be continued in
active service in the office he now fills so admirably, so that
neither his work nor his plans may be interrupted; and
affirming the necessity of a prompt increase in the num-
ber of beds in the tuberculosis hospitals and sanatoriums
throughout the United States and urging that the capital
issues committee of the Federal Reserve Board of the
United States Government allow permanent buildings to
be constructed in all cases in which the difference is not
too great in order that it may not be necessary to repeat
the process a few years later or to waste the money which
it is so difficult to obtain for any kind of construction.
Meeting of the Michigan State Nurses' Association
The Michigan State Nurses' Association, which held its
annual meeting at Bay City, May 21 to 23, elected the
following officers for the ensuing year: president, Eliza-
THE MODERN HOSPITAL
49
beth Parker, East Lansing; first vice-president, Fantine
Pemberton, University of Michigan Hospital, Ann Arbor;
second vice-president, Lucy E. Ramstead, Newberry; re-
cording secretary, Annie M. Coleman, Oakland Building,
Lansing; corresponding secretary, Anna M. SchiU, Hurley
Hospital, Flint; treasurer, Christine M. Hendrie, Blodgett
Memorial Hospital, Grand Rapids; councillors, Lystra E.
Gretter, Detroit, and Ida M. Barrett, Blodgett Memorial
Hospital, G;-and Rapids; chairman, standing ways and
means committee, Effie M. Moore, Detroit; chairman, cre-
dentials committee, Effie Tyrel, Battle Creek; chairman,
nominating committee, M. S. Poy, Battle Creek Sani-
tarium, Battle Creek; chairman, printing committee, Har-
riet Leek, Grace Hospital, Detroit; chairman of the special
committees, Lystra E. Gretter, Red Cross committee, De-
troit; Ada P. Coleman, public health committee. Grand
Rapids; and Mary A. Welsh, legislative committee, Blodg-
ett Memorial Hospital, Grand Rapids.
First Annual Meeting of the Minnesota Hospital
Association
The first annual meeting of the Minnesota Hospital
Association, organized in April last year, was held in
Minneapolis, June 27 and 28, at the new Curtis Court
Hotel.
A comprehensive program dealing with general and war-
time problems was presented, one whole session being-
devoted to the discussion of the nursing problem of the
smaller hospitals. A round-table conference on conserva-
tion and every-day economies and details of hospital man-
agement was a valuable feature of the program. An
automobile drive around the lakes within the city and
luncheon at one of the near-by country clubs furnished
pleasant diversion.
The officers of the association are: Dr. G. W. Olson,
superintendent Swedish Hospital, Minneapolis, president;
Lieut. G. H. Murray, late superintendent More Hospital,
Eveleth, now at Camp Dodge, Iowa, first vice-president;
Rev. J. A. Krantz, superintendent Bethesda Hospital, St.
Paul, second vice-president; Sister Mary Joseph, superin-
tendent St. Mary's Hospital, Rochester, third vice-presi-
dent; Mrs. G. G. Eitel, superintendent Eitel Hospital, Min-
neapolis, secretary-treasurer. These, with Miss Harriett
Hartry, St. Barnabas Hospital, Minneapolis; Rev. Henry
Hartig, St. Andrew's Hospital, Minneapolis, and Dr. S. G.
Cobb, Cobb Hospital, St. Paul, constitute the executive
committee.
An Hlinois Course for Community Nurses
Plans have been practically completed for the establish-
ment in Springfild of a two-month emergency post-gradu-
ate course for community nurses to be conducted by the
State Department of Public Health, the State Depart-
ment of Public Welfare and the Illinois Tuberculosis As-
sociation, with the cooperation of the Chicago School of
Civics and Philanthropy, the Elizabeth McCormick Memo-
rial Fund, the Chicago Tuberculosis Institute and other
state local health and welfare organizations. The course
will occupy but two months and no fees or charges of any
kind will be made. Only graduate nurses registered in
Illinois or in the states in which they reside are eligible
to the course and in filling the classes preference will be
given to those who agree to engage immediately in pub-
lic service nursing in Illinois.
Those who are responsible for the development of this
course recognize that the time allotted is not sufficient
for thorough training in community work, but this special
course is arranged particularly as a matter of emergency
to meet the acute need for community nurses brought
about by the demands of the American Red Cross for
military service and by the tremendous development of
the many social activities in Illinois within the past year.
According to the tentative plans now under considera-
tion, three weeks of the course will be devoted to didactic
and practical instruction in Springfield, after which the
nurses will be sent in small gioups to serve in the visiting
nurse services of the several Illinois communities in which
medical social work is being carried on with a high degree
of efficiency. One week of the course will be spent in
tuberculosis sanatoriums or hospitals in which intensive
public health instruction will be given. The final week
will be spent in Springfield and will be devoted to exami-
nations, round table discussions and the rounding up of
the course.
The faculty for this course will be drawn from the
staffs of the State Department of Public Health, the State
Department of Public Welfare, the Illinois Tuberculosis
Association, and the Elizabeth McCormick Memorial
Fund, and it is expected that part of the instruction deal-
ing especially with state charities will be carried out in
the several state institutions. The fields included in this
brief course of instruction are communicable diseases,
rural sanitation, general visiting nursing, tuberculosis
nursing, dispensary methods, child welfare, school nurs-
ing, juvenile and adult delinquency, jails and almshouses,
mental hygiene, health service, elementary laboratory
methods, all of these subjects being given consideration
especially from the small community standpoint.
Aside from the many vacancies in community nursing
service brought about by the demands of the American
Red Cross, a large number of counties and municipalities
have recently appropriated funds for public health and
social service nurses, while funds for fifty additional com-
munity nurses were created this year through the sale
of Red Cross Christmas Seals. — Illinois Health News.
Great Work Accomplished by the Canadian Red Cross in
1917
The work of the Canadian Red Cross since the outbreak
of the war has been tremendous. This society is sub-
divided into 772 local chapters; 6 hospitals have been or-
ganized in England itself; 28,500 crates of hospital mate-
rial, etc., have been distributed among various hospitals
in France and Africa through the medium of the French
Red Cross societies.
The Canadian Society also supports recreation huts for
convalescents. The 59 ambulances belonging to the asso-
ciation transported more than 32,500 wounded during the
summer months of 1917.
In 1916 the Canadian Red Cross contributed $365,000 for
wounded soldiers of the United States forces, according to
information recently communicated to the national head-
quarters of the American Red Cross by the chairman of
the executive committee of the Canadian Red Cross. — Red
Cross Bulletin.
Canadian hospitals in France are helping to care for
Red Cross work in France alone.
There are three kinds of people in the world: the Wills
— the Won'ts — and the Can'ts The first accomplish every-
thing; the second oppose everything; the third fail in
everything. — Friend's Calendar.
50
THE MODERN HOSPITAL
Conducted by MISS ANNIE W. GOODRICH.
Teachers' College. Columbia Universily. New York City.
Please address items of news and inquiries regarding Department of
Nursing to the editor of this department. Teachers' College, Columbia
University, New York City.
THE ARMY SCHOOL OF NURSING
Plan for Furnishing Nursing Care to the Sick and
Wounded in Military Hospitals
The authorization, by the Secretary of War upon the
recommendation of the Surgeon General of the Army, of
the establishment of the Army School of Nursing has put
into operation a plan whereby the sick and wounded men
in our military hospitals may receive care through the
method that has been found most effective in the civil
hospitals. The school will also afford the opportunity so
eagerly sought by our young women for patriotic service
and, through the high standard for admission and the
thorough professional training it is prepared to provide,
gives promise of an army of highly qualified nurses to
carry on the reconstruction work that will be needed after
the war in this and other countries. The course as
planned leads to a diploma in nursing should the mili-
tary hospitals continue in operation for the full period
of the course. Should the cessation of hostilities occur
before the completion of this period, credit for all
branches of nursing completed will be given in a
certificate by the Army School of Nursing, which cer-
tificate will entitle the holder to recognition by such
civil hospital training school as may subsequently
accept her as a student. The school is located in the
Surgeon-General's office, Washington, D. C; the training
will be given in the various military hospitals and through
such affiliations as may be required to complete the course.
The military hospitals will provide experience in surgi-
cal nursing, including orthopedic, eye, ear, nose, and
throat; medical, including communicable, nervous, and
mental diseases. Experience in the diseases of children,
gynecology, obstetrics, and public health nursing will be
provided through affiliations in the second or third year
of the course.
Lectures, recitations, and laboratory work will be given
in the required subjects, each hospital assigned as a train-
ing camp having its staff lecturers, instructors, and super-
visors, and teaching equipment.
The course extends over a period of three years. Credit
of nine months, or approximately an academic year, will
be given to graduates of accredited colleges. Credit of
three or four months will also be given to students who
have had two or more years of college worl^ that has in-
cluded prescribed courses in the sciences.
To be eligible to the Army School of Nursing, candi-
dates must be between 21 and 35 years of age, in good
physical condition, and of good moral character. They
must be graduates of recog'nized high schools or present
evidence of an educational equivalent.
No tuition fee is required. The students will be pro-
vided with board, lodging, and laundry throughout the
period of the course, and with the required text books.
They will be required to provide themselves with indoor
uniforms for the preliminary course, and upon its success-
ful completion, with an outdoor uniform, and such addi-
tional indoor uniforms as are required during their resi-
dence in the school. A monthly allowance of $15 to meet
these and other school expenses will be provided, except
for the period of affiliation.
It is hoped to establish the first units on or about July 1.
The board of the Albany Hospital, Albany, is releasing
Miss Sallie Johnson to establish a unit in the vicinity
of New York. Similar assistance is being considered by
the board of directors of other important hospitals.
The advisory council appointed to advise concerning
the affiliations with the civil hospitals and the general
policy of the Army School of Nursing is composed of the
following members: Colonel W. H. Smith, chairman;
Colonel C. L. Purbush; Colonel W. T. Longcope; Miss M.
Adelaide Nutting; Miss Lillian D. Wald; Miss Anna C.
Maxwell; the superintendent of the Army Nurse
Corps; the superintendent of the Navy Nurse Corps;
the director of the Department of Nursing, American
Red Cross; the president of the American Nurses' Asso-
ciation; the president of the National League of Nursing
Education; the president of the National Organization
of Public Health Nursing; the dean of the Army School
of Nursing.
In many of the military hospitals are to be found men
and women prominent in the medical and nursing world
through whom the school is assured of a strong faculty.
The school is fortunate in obtaining the services in
the office of the school of such prominent nurses as Miss
Helen Scott Hay, who has been released by the American
Red Cross office in Washington, Miss Ellen Stewart, for-
merly superintendent of the Clarkson Memorial Hospital,
Omaha, Neb., Miss Anna C. Jamme, who has been given
a leave of absence by the State Board of Health of Cali-
fornia; while Miss M. M. Riddle of the Newton Hospital,
Mass., has been released by her board of directors to es-
tablish in the immediate future the training unit at Camp
Devens.
The Women's Committee of the Council of National De-
fense, the Red Cross, and the Nursing Committee of the
General Medical Board of the Council are preparing an
extensive program for the recruiting of students for both
civil and military hospitals. Great and sympathetic in-
terest in the Army School of Nursing has been already
demonstrated by the various branches of the Junior
League, an organization that represents many young
women who would like to render this service at this time.
Hostels for Disabled Men
A new Eccentric Club hostel was opened at 5, St. Agnes-
place, Kennington Park, on May 2nd, by the lord mayor
of London. The house has been provided by Mr. Walter
De Prece for the accommodation of disabled and dis-
charged men from Roehampton Hospital while they are
learning trades, and will contain 25 beds. This is the
thirteenth hostel which the Eccentric Club has fitted
up. . . . There is a waiting list at Roehampton Hos-
pital of many thousands. Already the club has provided
for nearly five hundred of these men, and five more hostels,
will shortly be opened. — Lancet.
THE MODERN HOSPITAL
51
Conducted by MISS LULU GRAVES.
Please address items of news and inquiries regarding Department of
Dietetics to the editor of this department, in care of The Modern Hos-
pital, Conway Building, Chicago.
In the May issue of The Modern Hospital there was
published in this department a paper on "The Economical
Preparation and Serving of Food," by the editor of this
department, which was read before the Ohio State Hos-
pital Association a year ago. Unfortunately, this paper
was printed without proper revision. Mention was made
therein of the need of saving potatoes, and some foods
which might be used to help in conserving potatoes. This
furnishes one more proof of the danger of making definite
statements with reference to our food supply. This
situation is changing so rapidly that the thing we advo-
cate doing this month may not be at all the thing to do
next month ; the statement made in regard to the use of
potatoes a year ago was decidedly an error at this time.
The following are "pointed paragraphs" taken from the
bulletins on food conservation sent on by the department
at Washington :
WHY RYE FLOUR WAS REMOVED FROM SUBSTITUTE LIST
"Numerous inquiries have come to the Food Adminis-
tration asking why rye flour was removed from the list
of substitutes for wheat flour. On May 1 it was estimated
that there remained but 16,000,000 bushels of rye in the
United States. Against this amount our normal consump-
tion of rye from May 1 to August 1 amounts to 31,000,000
bushels. If rye flour had been continued on the substitute
list our available supply would not have lasted one month.
In order that there might be even a limited supply for the
normal uses of rye flour, this cereal was taken off the sub-
stitute list."
POTATOES FOR WHEAT
"America has fallen behind in its shipments of food to
Europe. We must make up our obligations now by send-
ing more cereals, especially wheat. Eating potatoes is
one way to increase the supply of wheat.
"We have the potatoes — millions of bushels are avail-
able now; they won't be as good three months from now.
To conserve both wheat and potatoes
"Eat Potatoes
NOW
and
get such an enthusiasm for potatoes that next year's pro-
duction will beat this year's.
"Germany gets 200 bushels of potatoes to the acre, the
United States less than 100 bushels. Germany raises five
times as many potatoes as the United States in less than
one-tenth our area. We can and will do as well.
"But that's for the future. For now. Eat potatoes;
save wheat — and redeem our obligation to the allies."
WHE.\T SAVING IN HOSPITAL
"The largest hospital in the state of Maine has been
saving from four to six barrels of wheat flour a month
since the inauguration of the savings campaign. This
saving has been effected by the increased use of cereals
with sugar and milk or cream. The hospital practically
average.s four and two-thirds wheatless days each week.
Everything possible in cooked foods requiring sugar has
been cut out and every possible means is used to save food.
All this is done without reduction in sustaining value of
food served."
FOOU CONSERVATION IN MILITARY HOSPITALS
Reduction of Waste at Camp Sevier Base Hospital Through
the Work of a Food Conservation Board — Cooper-
ation of Cooks and Men an Important Factor
"An economical use of food has always been funda-
mental to really good housekeeping," says the Military
S}u-geon, "and the appeal now making to 'save food and
win the war' has no application to such, for 'saving food,'
in the proper sense of the term, is the essence of good
housekeeping. But a good housekeeper is a vara avis,
and such birds are usually of the feminine gender, while
among men housekeeping, like olives, is an acquired taste
and rarely reaches above mediocrity." Thus runs the
editorial introduction to the following views of Major
John S. Dye, M. R. C, on duty at Base Hospital, Camp
Sevier :
To send two hundred and twenty million bushels of
wheat to our allies, when we have a surplus of only eighty-
nine millions, seems impossible until we realize that to
have the required surplus we should get it down to a con-
crete basis and know the part that each individual must
play; then it looks easy, for if each person saves weekly 1
pound of flour, 7 ounces of meat, 7 ounces of sugar, and
2 ounces of fat, it is done. After our personal experience
in food conservation at this hospital the statement that
"Enough food is wasted in America to feed France" ap-
pears to us a fair, but awful indictment.
Early in the organization of this hospital it was realized
that a great deal of good could be accomplished by proper
conservation of food and prevention of waste. There
have been apparently insurmountable obstacles presented
in this work, such as inexperienced cooks, unaccustomed
to handling army rations, inexperienced help in all depart-
ments; and with the exception of the commanding officer
and one other officer, there was not a single man connected
with the base hospital here with any considerable army
training. On or about October 2.5, 1917, Major Scott,
commanding the base hospital, detailed verbally Major
E. H. Goodman, Captain C. W. Woodall, and myself to
look into the matter, and a few days later issued the
following memorandum, at our suggestion :
MEMORANDUM
1. After each meal, all foods that are left from the
various messes of this hospital will be separated into
different kinds, such as meats, breads, vegetables, etc.,
and will be inspected by an officer before it is incinerated.
2. Lieutenant Woodall will make this inspection at the
general mess, and Major Dye at the officers' mess, nurses'
mess, and the hospital corps' mess.
3. Bread will be sent into the wards in loaves and cut
there, and the slices, after being cut, will be cut in half
and served. Foods sent back from the wards will be in-
spected before incinerating.
4. Note will be taken of the amount of waste from each
ward and a report of the same made to the mess officer.
Medical officers and nurses in charge of wards will use
every effort to prevent the waste of all foods, particu-
larly bread, butter, meats, and sugar.
5. Food sent to the contagious wards will be sent in
containers; gi-eat discretion will be used in the amount
sei . od to all patients, and the food remaining in the con-
tainers will be sent back to the mess and utilized. The
bread sent into the contagious wards will be left there and
used in making milk toasts, etc.
52
THE MODERN HOSPITAL
6. Food remaining in all other wards will be sent back
to the mess and utilized.
7. The mess officer and the officers' mess, the mess offi-
cer of the hospital, of the detachment, and the nurse in
charge of the nurses' mess will send a menu of food
served, to Major Dye's office daily.
8. The following food conservation board has been ap-
pointed at this hospital: Major John S. Dye, Major Ed-
ward H. Goodman, and Lieutenant Charles W. Woodall.
This board will act as a permanent advisory board in all
matters pertaining to the supply, conservation, prepara-
tion, and serving of foods in the hospital, and their recom-
mendation and orders regarding the same \yill be obeyed
and respected. „ „ „
(Signed) T. E. Scott,
Major, M. C, Commanding;.
This board was to exercise a wide range of power in
all matters connected with the messing facilities of th'e
hospital. It was made plain that the object of this board
was not to reduce the food of the patients to a minimum ;
that all patients must have a sufficient amount of food,
well prepared and served in an appetizing manner, so that
there could be no excuse for waste on the part of con-
sumers; that every man was to have all the food he de-
sired; that no one was to tvaste anything.
The board then proceeded to make a complete and care-
ful survey of the situation. It found that a great deal
of food was not well prepared and not appetizing, due to
the inexperience of the cooks, that the cooks themselves
were making no effort to save food, and the patients were
also wasteful in the use of food. Captain Woodall, the
mess officer, found on investigation that the medical de-
partment men were getting 5,500 to 6,000 calories per day;
this was considered too much. The caloric value of foods
fed to patients was also worked out for each meal for a
period of seven days, showing that the regular diet pa-
tients received on an average of 2,500 to 3,000 calories,
light diets 2,200, and liquid diets 1,000 calories per day.
This was considered a sufficient amount for men not per-
forming manual labor. Experiment has shown that an
individual in bed eight hours, and resting in a chair six-
teen hours, uses 2,1(58 calories, while men on light duty,
resting most of the time, will use 2,488 calories. A bal-
anced menu, based on the above figures, is worked out
each day, and this is multiplied by the number of men to
be fed. We have found that the number of calories ar-
rived at by this process is more than sufficient to satisfy
the hunger and meet all physiological needs of the men.
Men resting in the hospital do not require a diet of 3,500
calories, and such an amount is directly injurious in many
cases in that it throws extra work on the metabolism of
an individual whose physiological functions are below nor-
mal.
The first problem of the board was to secure earnest
cooperation from the cooks and men handling the foods.
With this object in view lectures were given to the medical
department men, showing the necessity of saving and the
methods by which it could be done. Cooks were given
special talks and instruction in saving food, during its
preparation. This propaganda of instruction was ex-
tended to the nurses so as to get their cooperation in the
ward diet-kitchens. In each one of these talks, it was
urged that everyone write to the families and try to start
a food conservation propaganda in the homes. For the
purpose of interesting patients in the hospital and securing
their entire cooperation, various signs were printed and
hung in each ward. These are circulated daily so that a
new sign is in each ward every day. . . .
This bulletin v/as issued by the board:
Conservation of Meat. — There shall be one meatless meal
each day and two meatless days each week, for all the
messes in this hospital, including the officers' mess, sub-
stituting for meat, sea-food and articles of vegetable diet
rich in protein.
Conservation of Wheat. — There shall be one wheatless
day, or three wheatless meals served during each week,
corn, rice, and other cereals being substituted for wheat.
Conservation of Sugar. — All sugar and desserts requir-
ing sugar will be eliminated from the noon-day meal, ex-
cept on Sunday.
Conservation of Fats. — No butter will be served at the
noon meal except on Sunday, and the frying of food in
fats will be avoided as much as possible.
Conservation of Waste. — At the end of each meal one
of the board will inspect the waste from each mess, and
the food returned from each ward, before it is incinerated
or thrown into the garbage-cans. No meats, breads,
cereals, or potatoes, even if they have been on a man's
plate, will be wasted, but it will be recooked and served
again, except the food returned from the contagious and
venereal wards. Bread will be sent to the wards in
loaves, and the ward surgeon or nurse in charge will see
that the slices are cut thin and then cut in half. The
patient may have as many half slices as he requires. In
the contagious and venereal wards, the bread will not be
returned to the mess, but kept in the ward for making
toasts.
When waste is discovered in foods returned from a
ward, it is reported to the mess officer, who in turn calls
on the ward surgeon for an explanation. Nurses and
ward surgeons are held responsible that no waste occurs.
Food is taken into the wards in quantities, and individual
service made from the ward diet-kitchen. Any excessive
waste from a ward is not only ample proof that negli-
gence has occurred, but is also proof that a sufficiency of
food is served to the ward; so that a nurse stating that
her patients have not had enough to eat must first show
that she has not thrown into the garbage-can food intended
for such patients. The object of the board in controlling
this waste has been to place the responsibility for the
waste directly on the person who is responsible, and in
this way immediate and definite results are obtained.
Ward surgeons and nurses are instructed by the mess
officer that they may have for their patients all the food
desired ; that if one serving is not sufficient, as many more
as are necessary may be made, so that there has been
no restriction whatever in the amount of food furnished
the wards. It is only that they must show that such
food has been properly used and none wasted. This state-
ment is in apparent contradiction to the statement that
a certain number of calories of food are furnished to cer-
tain classes of patients, but rations prepared by our
caloric estimates have proved more than ample, so that
the surplus enters into the estimate of the amount to be
cooked for the next meal. Special diet cases, and seri-
ously sick cases, of course are fed all articles required
by the ward-surgeon, no restrictions whatever being placed
on these.
All kinds of foods, such as meats, bread, and vegetables,
are returned from the wards in separate dishes. In the
kitchens the cooks keep their various kinds of waste in
separate containers. Dirt is matter out of place; garbage
is food out of place.
Because of the work of our board, the reduction in waste
has been most remarkable. From an inordinate waste of
large amounts of perfectly good food, and particularly
of those foods that we must save — wheat, meats, fats, and
sugars — the hospital has reached a point where there is
not more than one ordinary garbage can full of waste
daily, most of this being vegetable material that cannot
be re-served. Apple and orange peeling, celery tops, and
other coarse materials are not included in this estimate.
Happy is the man who does all the good he talks of.-
Italian proverb.
THE MODERN HOSPITAL
53
HOSPITALISM— ITS CAUSES AND TREATMENT*
Definition — Personal Causes: Poverty. Malingering, Lazi-
ness, Lack of Will Power, Imperfect Diagnosis — Gen-
eral Causes: Social Conditions, Lack of Facilities
for Diagnosis, Misconception as to Purpose
of Hospital — Treatment — Hospitalism
in Relation to Employees.
In the somewhat brief and incomplete discussion which
is to follow we are to consider "hospitalism" in its bearing
not only upon the patients in our hospitals, but upon our
employees as well.
For some years there has been in common usage about
the hospital corridors a term by which an attempt has
been made to define a certain class of patients. You have
heard and so have I, "What's wrong with the patient in
A 6?" "Oh, nothing but 'hospitalitis.' " This class is not
at death's door. It is not moribund ordinarily, but it
comprises those who under right surroundings and cir-
cumstances would be physically and mentally well. It is
the average patient; that active class not acutely ill, but
who ordinarily are in a chronic condition of whom we
W'ould speak.
DEFINITION
What, then, is "hospitalism" or "hospitalitis"? One
says, "It is the disease of enjoying a hospital"; another,
"It is the term applied to that one who simply has the hos-
pital habit." Certain it is that it does not refer to the
hospitalization of the people; or to the inci'easing popular-
ity of the hospital in these times when people go to the
hospital to get well, not to die. It refers to a somewhat
indefinite, sociological problem. It does not refer to the
dictionary definition, "Hospitalism is that morbid state
due to impure air in a hospital," nor could we state with
truth that it is caused by any mechanical part of such an
institution, but it would seem to be comprehended for the
moment in this definition: "Hospitalism is that state of
apparent satisfaction with his surroundings or lack of per-
sonal initiative which permits a patient, often in a chronic
condition, to enjoy the care of a hospital to an abnormal
degree."
Again, it refers to those who. not passively, but actively
because of social conditions or accidents, and themselves
unable to see the reason for their own failure, are forced
to turn to that institution in the community which replies
to the statement, "I'm sick" by, "What's wrong? Let's
see." The term cannot rightly be applied to those whose
case has been improperly diagnosed.
We should further limit the discussion of "hospitalism"
and confine it to that class commonly known a.s "the poor,"
for, as one of my friends has so happily remarked, "Hos-
pitalitis in the wealthy patient is usually incurable, for
the hospital usually dare not, and the patient usually will
not, do what he ought." Of the wealthy, then, we will
not speak at all, but of the larger problem which interests
us just at present, that of the care of the poor and great
middle class.
PERSONAL CAUSES
The causes of "hospitalism" may be either personal, re-
ferring to the patient alone, or may be general and make
society responsible for their origin. Among the personal
causes we would place as most important poverty. The
vicious cycle, "poverty, sickness, poverty" or "sickness,
poverty, sickness," is without doubt the cause of a great
deal, if not the major portion of our "hospitalitis" cases.
We might divide this poverty-stricken class into two sub-
divisions; fir.st, that in which life is a defeat and the in-
dividual is unable to maintain itself in the great struggle
for existence, and, second, that class in which life is a
.struggle, but not a continual, an everla.sting defeat. Any
remedial measures applied to the former class of patients
are practically worthless, unless they can be lifted out of
their class entirely into the second, and even there they
will need assistance and temporary relief at many turns
of the road. The question of the bearing of poverty upon
the "hospitalitis" case is a large one and can best be
solved by the sociologist. Of the treatment a little later;
.sufficient now to speak of poverty as a cause of "hospi-
talism."
Another cause of "hospitalism" is the development on
the part of the patient of a real affection for the hospital,
for the nurses, the physicians, all in attendance. Com-
pared with the home surroundings, the hospital is a ver-
itable heaven, the nurses ministering angels, the physi-
cians wizards of superhuman knowledge. Is it any won-
der that after discharge such patients easily trump up
an excuse to return? Why, I have even known of such
among wealthy patients who, after a pleasant hospital
experience, even though a most serious surgical operation
has been undergone, would greet you somewhat after this
fashion :
"I want to tell you what a delightful time I have had
while I have been here these three weeks. It has been
so restful, so free from care. Everybody has done every-
thing they possibly could to make my stay pleasant and
I have told my husband that when he goes off for his
vacation up in the mountains, I'm going to return here for
mine, just for a good rest and to enjoy it without the
suffering."
A third class is the malingerer, pure and simple, a class
represented as such in medical circles.
To illustrate, let us use the words of the executive of
one of our best hospitals:
"A single man of 30, a member of a sick benefit lodge, which was
paying his hospital expenses, complained of stomach trouble. After
the patient had been a week in the hospital, the doctor, finding no
serious trouble, told him to go home. The man did not wish to go.
and the next day complained of a serious pain in his knee. An ex-
amination showed nothing the matter, and it was decided the man was
looking for a place to stay and take it easy as long as the society
would foot the bill. He was put on a diet of soup, and a fly blister
put on his knee. He left the hospital entirely cured the next day."
A fourth class might be associated with the malingerers,
and yet they are truthful enough, are lazy, or perhaps,
they lack will power. They are those human parasites
which occur in every large community referred to face-
tiously by the youngsters in a certain town:
■Buffalo Bill lives on a hill.
He never works and he never will."
The treatment for this class would be to secure sentence
under some of our war legislation, which makes impera-
tive thirty-six hours' labor in a week or imprisonment.
One of our good friends suggests, "Simply give that fellow
a war job."
In a similar class is the neurotic, and he needs real con-
sideration. Very often the physician and the nurse pass
by him, merely saying, "Oh, he's simply got a case of
nerves. Nothing much the matter with him." Says the
superintendent of a large Eastern hospital:
"Personally. I have always felt, and my feeling increases with the
years, that the doctors and hospital people are entirely too ready to
consider a person neurotic or 'hipped.' I am absolutely certain in my
own mind that many of the patients who are accused of being neu-
rotic, or who have "hospitalism* as I undei-stand it, really have some
54
THE MODERN HOSPITAL
condition which the doctors have not discovered. We all know that
there are many obscure cases, and when the doctor cannot put his
finger definitely upon the spot it is very easy to blame it on the
nerves."
The treatment of this class, provided, of course, the
diagnosis has been established, and the case is one of
"nerves," should be given to the neurologist, who with his
suggestive therapeutics, mental therapeutics, hydrothera-
peutics, or his electrotherapeutics may restore the normal
condition.
Right here is where we may learn much from our
present enemy, the German, who for many years has made
so much of his bath house. Perhaps, with the war's new
demands for curative agents, we will turn to similar
means for assistance in our new ti-eatment work and
make some decided advancement along therapeutic lines.
Fifth, there are those who are hospitalized or have
"hospitalitis" because of some great misfortune or acci-
dent; for instance, industrial workers not under compen-
sation laws, or our soldiers, maimed and disqualified for
military duty and cut off from their ordinary occupations
when discharged; no longer able to make a livelihood
through the accustomed channels, they have no heart to
learn a new trade.
Special treatment is needed by this class, and this is
particularly true of our soldiers who may be returned in-
capacitated for future duty in the army. They must first
be brought back to health and then receive such special-
ized treatment as will place them at least in a self-sup-
porting position. Canada has much to teach us in this
line; much of good, many mistakes. It is all very Inter-
esting, and should receive our most careful attention now.
Perhaps we will have no case so extreme as the fol-
lowing, yet it will serve as an illustration : There was a
group of Jamaicans who had served the mother country
in the war, been wounded and sent to Canada for conva-
lescent treatment.
"Nine had had both legs amputated below the knee, eight lost one
foot or most of one foot. In the West Indies they had been cultivators,
•earning from ten to fourteen shillings per week. Their case was taken
up by the Canadian Military Hospitals Commission with the govern-
ment of Jamaica, which reported that if the crippled men could get
training as shoemakers or garment-makers, they could earn a liveli-
hood on the island. In less than five months eight of the men were
trained to the point where they could do ordinary shoe repairing as
well as the journeyman ; two showed such aptitude for cobbling that
they could make custom-made shoes. Three showed a 60 percent effi-
ciency as garment-makers. One, in tinsmithing, could make an ordi-
nary utensil if given the pattern, although he was of such a primitive
type that he could not distinguish differences smaller than a quarter
•of an inch. One was trained to be a chauffeur (he had had some ex-
perience before) ; and one completed two-thirds of a course in stenog-
raphy and typewriting. , . .
"Jamaica paid the cost of maintaining, equipping, and training
the men. Instead of the unskilled farm hands who had left the island,
instead of helpless war cripples, prospective dependents for unnum-
bered days, seventeen producers, with enough artisanship to earn for
themselves more than they had ever earned before, they sailed south
from Halifax to take up life hopefully in spite of their desperate
maiming."
There must be the planning for systematic vocational
work, if instead of discouraged, dependent, pensioned, or
■"ho.spitalized" wrecks in the worst sense of the term, we
are to have those who are self-respecting, self-supporting
citizens. As hospital people realizing the need, it will be
our duty not only to provide adequate hospital facilities
to bring back health to our returning soldiers, but, also,
as The Survey so aptly puts it, "to civilize after the men
have been militarized," to give hope and encouragement.
You are to hear at length from others along this line;
sufficient for me to call your attention to the advisability
of the proper care of this class if we are not to have
many of them afflicted with "hospitalitis."
GENERAL CAUSES
I have spoken of the personal causes for hospitalism;
now of the general causes. First, a patient may be in this
general class because of social conditions, conditions which
are beyond remedy by an individual, a hospital, or a class,
but which require the combined action of all society. I
shall attempt no solution, but shall simply call your atten-
tion to the fact.
The second general cau,se, and I am inclined to think
an important one, is carelessness on the part of our staff,
both visiting and house, perhaps in diagnosing the case,
and in prescribing the treatment or in following the case
after it leaves the hospital, the reason being, ordinarily,
that the case is not interesting or the staff is inadequately
manned or organized. Perhaps the staff man on service
has too much work thrust upon him to give the individual
obscure case the consideration which it deserves, and so:
we hear, "Just a little bit nervous, that's all," or "He's
been here before," buries the patient, perhaps literally.
To illustrate the point, let me quote a member of this
association, who says:
"The patient, a well-developed girl of about 18 years of age, had been
confined to bed in various hospitals for about two years. She was not
able to walk or even stand on her feet. An examination disclosed no
physical disease. With the permission of the attending physician, the
superintendent and his wife took the patient in hand. By patient work,
at the end of one week she was able to stand by the side of her bed.
She was given crutches, and at the end of another two weeks she was
able to walk a little. At the end of the seventh week she was able
to go shopping and to the theater without the aid of cane or crutches,
and was sent to her home cured. Her 'hospitalism' was due to long
confinement and lack of time for study of her case."
A third cause may be that the hospital lacks the facili-
ties for establishing a true diagnosis, has no laboratory,
no roentgen ray, etc.
It may also be true that the hospital lacks a follow-up
system, and this is probably one of the largest causes for
"hospitalism." It has, however, decreased within the past
few years since the establishment of the social service
worker, that important addition to the hospital's staff.
Because of the follow-up system, the patient is now made
to feel the hospital has a personal interest in him, and,
instead of his seeking advice at another hospital, he re-
turns to the place where he was given original treatment
for further care and advice, until his complete recovery
is established.
As an adjunct to the follow-up system there should be
in every town of any size a social clearing house, where
accurate information regarding every so-called charity
ease will be kept, available not for one hospital alone, but
for all agencies at work; such, for instance, as that which
is maintained by the Associated Charities in Cleveland or
the Confidential Exchange of Information in Baltimore
and in Boston.
Another general cause of "hospitalism" is the lack of
cooperation between the visiting staff and the admitting
officer of the hospital. Many a patient has slipped by
the admitting officer because that officer has not demanded
a definite diagnosis before admission or when the visitant
desires admission for a patient to establish a diagnosis,
the case is not followed up with promptness and a diag-
nosis required within a few days, and so the patient stays
on indefinitely until finally it becomes a real problem how
he can be removed from the hospital.
A sixth cause for "hospitalism" is a rank misconception
on the part of the public generally as to the purpose of
the hospital. "Why, Mrs. Jones told me to come here.
She said you took anybody that felt sick." Publicity is
needed to teach the ordinary citizen the real concept of
THE MODERN HOSPITAL
55
a hospital and the nearer that ordinary citizen gets to the
actual working, the better.
That ordinary citizen can often point out to the com-
plainant that it is not a hospital which is needed, perhaps,
so much as fresh air in the sleeping room. In this con-
nection, however, I would not minimize the value of expert
advice to the magnification of ineffectual, amateur at-
tempts at correction; I simply call attention to the fact
that the public may and should help the physicians and
the hospitals more than it now does.
TREATMENT
This is sufficient as to the causes, personal and general.
Let us now speak of the treatment. A patient should be
really cured while he is a patient in the hospital, not
turned out hastily. If this is not practicable, then a
patient should be followed into his home, or perhaps bet-
ter, should be placed in a convalescent home to recover
and come back to his normal condition in life.
I do believe the "follow-up system," as instituted in the
social service department of our best hospitals, will mean
much for the treatment of "hospitalism"; not simply to
obtain a "cure," but to inspire where there was discour-
agement before, to bring sunshine and confidence into the
midst of dreary surroundings and heart-breaking circum-
stances, "to restore respect to the downtrodden and pru-
dence to the thriftless"; to lift the patient up to a higher
plane of thinking, at least.
A third assistance in the treatment of such eases would
be a complete out-patient department, where patients may
return for post-discharge attention and possibly further
diagnosis.
Another real assistance, suggested a moment ago, is
that the public should be taken into the confidence of the
hospital and given not merely dry statistics, but as much
of the real work of the institution as it is possible to put
into print. Put some flesh on the bones of those dry sta-
tistics in your annual report. Get out a circular letter
regularly, a leaflet, a pamphlet and distribute them to
the supporters of the hospital. Keep your expatients
acquainted with what is going on. They will take a pride
in your work, will feel a personal interest, and will assist
in eliminating the repeaters. Do not forget the local
newspapers. Maintain their friendly interest, give them
all the facts to which they are entitled and an interesting
story now and then.
While I mention it last, I do not consider the value of
a regularly appointed and accredited "spiritual doctor" or
chaplain least in the treatment of the "hospitalitis" case.
I do not mean that person of "D. D." appellation who
baptizes the newly born and holds a religious service once
each week, but that man of large experience with the
world who has a firm hold upon life's great realities; who
goes about the wards with infectious smile and kindly
word of advice, lifting up the downhearted and centering
the thought in a great faith, giving a reason for living an
opportunity for service.
Whether poverty, real affection for the hospital, maling-
ering, laziness, "case of nerves," poor staff organization,
no follow-up system, inadequate facilities or lack of coop-
eration be the cause of "hospitalism," I am sure the use
of modern business methods applied to the problem and
the full use of available aids, such as the social worker,
better mechanical facilities, closer relations between staff
and executive, and perhaps a "spiritual doctor," will
accomplish much looking to the successful treatment of
such cases.
"hospitalism" and the employee
Let us now turn very briefly to "hospitalism" in its
application to our employees. We find it loses its flavor
of undesirability — becomes a desideratum — and that, if it
were not for the fact that our employees become attached
to their work, see in it more than is represented by the
pay envelope, become hospitalized, we would not be able
to maintain the standard of work which is now possible.
I venture to say that, as a class, hospital employees,
from the janitor up, can be outdone by no other class in
loyalty and steadfastness of purpose. Yet the wonder is
that so many are thus true when there is so little appar-
ent organization, so little financial reward. The truth is
we need hospitalized employees in these days of the high
and often exorbitant wages paid by the commercial indus-
tries. We need those who possess ideals, who stick to
their work for the love of it; and yet, if it is our good for-
tune to possess such an ideal lot of employees, is it not
our duty to encourage them, to be careful of the routine
of advancement, to make each position as attractive as
possible and so place an incentive before every worker?
Our employees need training, not firing. Not long ago
a prominent magazine made much of the "cost of firing,"
and it is true that we waste many thousands of dollars in
this country because of the thoughtless "firing" of
employees. We need better organization of our em-
ployees. Manufacturing concerns place foremen over
groups and secure a definite division of responsibility.
The workers are most carefully instructed in every de-
tail. Compare this with that engineer who takes his
orders from anyone in the hospital, that orderly who has
never had a lesson as to how to lift or carry a patient,
or the floor maid who, being told by the housekeeper to
sweep the floors, is dragged off by a probationer to help
clean a bed. Such rank carelessness in organization would
show up in the lack of dividends in a commercial industry
and would soon be banished, but in a hospital is simply
charged up to the "terrible expense of caring for charity."
Let the head of each department carefully ob.serve the
employee's work. Perhaps by a slight change this work
could be made attractive and the employee himself have
beer developed into a very valuable member of the organi-
zation. Let the superintendent herself or himself most
carefully observe everyone upon the payroll, and perhaps
there will be developed from that orderly your chief engi-
neer, or from that hard-working, conscientious nurse the
head of your surgical suite; perhaps from this maid your
future housekeeper; perhaps from this little country girl,
an e.xpert seamstress.
There should be an interest instilled into the work of
everyone. We have found an institution where the Taylor
bonus system has worked most admirably. A certain
wage is given for the work of that position and, provided
that employee accomplishes a certain block of work in
addition, a premium is awarded at the end of the month.
If, however, the following month, the employee does not
live up to the standard of the former month, 2.5 percent,
perhaps, will be deducted from that premium ; or per-
chance an even larger block of work has been accom-
plished, then an additional premium is awarded. The
money appeal is always very strong. Another way to
secure interest is to post upon a roll of honor the names
of all those who have not been tardy, have done their
work well, and been courteous to everyone, or award a
pin or badge for merit.
If foreign help is employed, classes in English and in
American customs may be maintained by the hospital and
this can be accomplished at very little expense by calling
56
THE MODERN HOSPITAL
for the assistance of the daughters of your board of lady
managers, perhaps. For the female employees classes in
sewing can be made a matter of profit to the institution.
Most hospitals give their employees treatment when
needed. Would it not be better to have it understood that
with the wage an insurance policy, as it were, is also
given and the health of that employee is insured? Hos-
pital care will be given if such is needed, not "free of
charge," but because it has been earned by the employee.
The same thing is true of the board furnished. Make the
value of the meals understood ; give meal tickets, which
must be presented at each meal and punched. Then when
comparing his position, dollar for dollar, with that in an-
other industry, where the meals are not included, he will
remember the value of his own position.
CONCLUSION
As we began by trying to define "hospitalism" in terms
more or less clear, we conclude that "hospitalism" is an
insidious disease, which may be one of the hospital's most
expensive liabilities, although in these days of modern
methods it should be turned into an asset for the com-
munity. When applied to an employee, "hospitalism"
should be openly known as one of the hospital's greatest
assets.
Ackncwiedgment is gratefully extended to the following for assist-
ance in the preparation of this paper : Stewart M. Johnson. London,
in "The Relationship of Poverty and Sickness and of Both to the Hos-
pital," Thk Modern Hospital, December, 1914, HI. 351 ; Mr. Asa
Bacon, Chicago: Dr. Thomas Howell. New York; Mr. Michael M. Davis,
Jr., Boston : Mr. Daniel D. Test, Philadelphia : Dr. H. F. Chandler ;
Mr. C. B. Hildreth, Cleveland ; Dr. John A. Hornsby. Chicago ; Dr. Ren-
wick R. Rcss, Buffalo ; Mr. P. W. Behrens, Toledo ; Dr. Joseph R. How-
land, Bcston ; Dr. Otho F. Ball, Chicago ; Major Warren L. Babcock. M.
D., U. S. A.
THE STANDARDIZATION OF HOSPITALS*
Reasons for and Against the Proposed Standardization of
Hospitals — Faith System Versus Business System —
The Former Allied to the Honor System
At the January meeting of the trustees, a communica-
tion was read and a questionnaire considered, coming from
the American College of Surgeons, relating to a proposed
standardization and classification of hospitals in the United
States and Canada.
It may be worth while to review the reasons for the pro-
posed "standardization" in the interest of a clearer under-
standing of this important project. It is alleged that, by
reason of curable defects, the majority of hospitals are
not doing the good work they should be doing. While it
is granted that the small hospital of limited means can-
not do all that can be done by the hospital with many beds
and a large income, it is held that the defects do not cor-
respond to size or always depend on poverty. Faulty or-
ganization, a poor equipment, and some other things are,
it is claimed, more often responsible than is poverty.
It does not appear that the College of Surgeons is aim-
ing at autocratic dominion. The college does not ask for
legislative powers to coerce, and it professes to believe
only in constructive and helpful criticism. This same
project has been discussed by the American Hospital As-
sociation at several sessions, so that it is not a new subject
to well-informed hospital workers. We fancy there are
few who will deny that much good may grow out of this
proposed standardization and classification. The argu-
ment runs something like this: The comfort and complete
•Presented, in abstract, at the February, 1918, meeting of the trus-
tees of City Hospital, Worcester, here reprinted by courtesy of the
Boston Medical and Surgical Journal,
recovery of the patients is of first importance. The ad-
vancement of the science of medicine and surgery, the
teaching of interns and nurses, and the welfare of these
student physicians and nurses while being taught are also
very important considerations. No hospital that cannot
make a fair showing in each of these important functions
can expect to be considered a Class "A" hospital.
It is held that a fair judgment may be had of the work
of a hospital by the care with which its work is recorded.
Hence it is that case records count for much to credit or
discredit a hospital.
It is alleged that only a few hospitals have an adequate
"follow-up" system, without which no one knows how
many of its discharged patients ever do fully recover. It
is alleged that neither the managing board, the surgeon
who operates, nor the superintendent in the average hos-
pital is likely to know what happens to a patient after he
leaves the hospital, unless he returns for further treat-
ment.
It is charged that "we put young graduates into your
hospitals as interns and nobody teaches them." "They are
left to run at their own sweet wills, provided they don't
get in the way of the machine — either the administrative
or the medical machine, each of which rolls through the
institution on its hurry-up schedule — and provided also
that they (the interns) do a certain amount of routine
work." "Nobody is responsible for their education."
"They gather crumbs, as it were, from the rich man's ta-
ble— chiefly the operating table! But so far as systematic
training is concerned they do not get it." "If they
'learn by doing' either they've got to have critical guidance
(teaching) or else the patients will suffer."^
It is claimed that, in the majority of hospitals, many
patients do suffer because the managing board requires
almost no accounting from a member of the staff once he
is appointed, and because the staff, speaking broadly, do
not examine the work or the medical records made by the
interns critically. It is claimed that this system — which
might be called a faith system because based on the far-
reaching quality of faith — is not businesslike, and as ap-
plied to hospitals, does not lead to "the substance of things
hoped for"; nor is it likely to produce "evidence of things
not seen." This may be said, however, that it is greatly
to the credit of the young medical men serving as interns
in hospitals run on the faith system that responsibility
does usually stimulate eight interns out of ten to do good
work in spite of a lack of systematic instruction. But
there comes a time, too frequently, when the one or two
of the ten become seniors and exemplars for younger in-
terns. Then it is that the want of systematic and careful
supervision works harm to patients and to the reputation
of the hospital. It is among the counts of the indictment
that the managing board of a hospital run on the faith
system never drops a member of the staff, once appointed,
until he has reached a fore-ordained age limit. It is also
charged that no member of the staff ever recommends the
release of an intern because of neglect of duty. This evi-
dence of faith and charity seems to the critics too one-
sided. They claim that too much faith and charity on
one side gives the patient a "raw deal."
It is urged, by way of argument, that no business enter-
prise can hope for success unless the directors, either by
personal examination or by proxy, keep in touch with the
quality of the work turned out by the several artisans and
experts whom they appoint to responsible positions. It is
urged, further, that it is unreasonable to expect an intern
to do his best in making records that he knows are not
IE. P. Lyon, Ph.D.. M.D., Minneapolis.
THE MODERN HOSPITAL
57
likely to be read by staff or trustees, at least while he is
connected with the hospital. It is claimed that a busy vis-
iting surgeon, depending on an exacting private practice
for bread and butter and means to support and educate a
family, is not likely to spend the necessary time to organ-
ize and maintain a "follow-up" system which is pretty
sure to lapse into desuetude as soon as the service is
turned over to his less painstaking colleague. Hence it is
argued that "it is as easy for a camel to go through the
eye of a needle" as for a hospital to do its best work under
the faith system of organization.
It seems that these reformers are not depending on the-
ory alone; many of the propagandists have had practical
experience. Many of them have had responsible positions
as visiting surgeons or physicians to large hospitals. Some
have had experience in trying to maintain a "follow-up"
system and a teaching system, to see it lapse and all their
efforts go for naught when the service changed. We may
suspect that this campaign is inspired by the remorseful
spirit of some departed surgeon, like Hamlet's father's
ghost, "doomed for a term to walk the night and for the
day confined to fast in fire." Perhaps! We cannot, how-
ever, find a scrap of evidence to support this fancy.
In all seriousness, it does seem worth while to know
where we stand in the eyes of disinterested and compe-
tent critics. If a business system, with its checks and
safety features, can be applied to professional work, those
who trust in us ought, of course, to have the benefit of
such a system. If the faith system is not the best system
for the patients, of course, it ought to go. A business sys-
tem is a system of checks and audits. A faith system applied
to hospitals trusts that the superintendent and every mem-
ber of the staff, once appointed, will do his best without
any auditing or supervision of his work by the managing
board. A business system insists that all the activities of
the hospital shall be audited and a report made to the
managing board at the board's regular meetings. The
faith system, according to the reformers, is intrenched in
the ancient castle of conservatism over the entrance to
which might be written, "As it was in the beginning, is
now and ever shall be." A business system owes no alle-
giance to a "slipshod" system because of the latter's hon-
ored lineage. The reformers insist that the end-product
of professional work is quite as important as the econom-
ics of the hospital, and that the professional work will
not rise to its highest level until it is audited, and followed
up with regularity by a competent auditor or an auditing
committee, which reports to the directors regularly.
Such are some of the arguments of reformers, voiced in
different phraseology, from many sources. The reformers
may not be all equally well informed; they do not agree
in all things, nor do they all speak with equally fair mod-
eration. Doubtless there might be something said on the
other side.
The business system applied to professional work is of
comparatively recent origin. Most of the progress in
medicine and surgery for the past hundred years has been
made under the "faith" system. We admit that much has
been accomplished. "In spite of the system" the reformer
retorts — but we know that the "honor system," much ex-
tolled by psychologists, is a near kin to the "faith" system.
Under a sense of responsibility and honor, the best men
do their best work, regardless of praise or blame. Stimu-
lated by a sense of honor and responsibility, young men
fresh from medical schools have done first-class work and
faithfully written comprehensive, time-consuming records
with no expectation that these records, with occasional ex-
ceptions, would be praised, blamed or even read by the
chiefs of staff.
We know that it is not essential for a man to hold a
professorship in a medical school to be a teacher, even a
first-class teacher. We have such men on our own staff.
In appointments and promotions, it may be true that the
teaching qualifications have not been sufficiently consid-
ered. We have no sympathy with the idea, sometimes as-
serted or implied, that a municipal hospital is handicapped
and must be handicapped by political considerations. When
the trustees of a hospital accept and adopt the principle
of a "closed" staff, they invalidate every excuse for inef-
ficiency. Efficiency is the one adequate defense of a
"closed" staff for a municipal hospital. When fifty men
are selected from a profession numbering three hundred
because of their supposed fitness, and given special privi-
leges in a municipal hospital denied to the two hundred
and fifty remaining members of their profession, they as-
sume grave obligations, and the directors assume the re-
sponsibility of holding them to whatever system observa-
tion and experience prove to work out best for the patient.
This, we think, will be accepted as a self-evident truth
whether or not we endorse all the ideas approved by the
American College of Surgeons. Whether or not any
change in our own organization is recommended, we should
dissent from any implication that a municipal hospital,
per se, is handicapped by political considerations. Noth-
ing in the history of our hospital warrants such an as-
sumption. Nothing in the past tends to show that the
people of our city do not want the best for their money.
Nothing indicates that the citizens of any live municipality
will fail Lo back the trustees in any move for the better-
ment of their hospital service — providing, of course, that
the hospital has not been made to serve the political for-
tune of any city or hospital official.
While we believe this is the simple truth, we are mind-
ful that medicine and surgery are not exact sciences. We
realize that the temperament and constitution of each pa-
tient are important factors — often unknown quantities — in
the equation. We know that it will require a broader judg-
ment to audit professional work than it does to audit the
financial activities of a hospital. And yet, the claim is
made that it can be done without hurting any man unless
it may hurt the feelings of the hypersensitive. How best
and by whom may professional work be audited and re-
sults followed up is an interesting problem for each hos-
pital.
The viewpoint of an able and sensitive surgeon, who has
given years to the service of a hospital working under the
faith system — which he regards as an honor system — may
be different from that of the reformers. He may see no
good reason why his time, much in demand, should be given
to details plus the reading and criticising of case records.
He may be willing to teach objectively, but not by time-
consuming precept. He may feel that teaching, in its or-
dinary sense, should be left to those with adequate salaries
— to those not dependent for an income on an exacting pri-
vate practice. He may feel that the audit system cannot
be fairly applied to professional work unless an auditor
be provided endowed with omniscience. His experience
with professing reformers may cause him to misjudge the
campaign in prospect.
The American Medical Association, the Catholic Hospi-
tal Association, the American Hospital Association, and
the Massachusetts Medical Society are enlisted for the re-
form as allies of the American College of Surgeons. Each
organization has a committee to help the hospitals in the
study and solution of the problems involved.
58
THE MODERN HOSPITAL
THE COMMUNITY HOSPITAL AS VIEWED BY A
NURSE
A Texas Hospital, Seventy Miles Away From a Sister
Institution, Wiiicli Does Original Research Work
Besides Successfully Caring for Patients.
Bv MARGARET HARRISON, Sureical Supervisor Kerrville Sanita-
rium-Hosi)ital, Kerrville, Tex.
The Kerrville Sanitarium has been in operation for
seven years. It is a semiprivate institution, originally
built to meet the local demand, but, ov^'ing to the combina-
tion of complete equipment, e.xcellent climate, and skillful
staff, it is nowr attracting patients from a wide area.
The building, which was erected by the citizens of the
arranged that when desired one half of the building may
be shut off and go unheated. This type of heating plant
is very satisfactory in a climate with such a wide daily
range of temperature, for much of the time when heat is
needed at all, just a little to temper the atmosphere in
the morning and after sundown is all that is required.
The building is provided with broad galleries so arranged
that they may be used both summer and winter.
The octagon operating room has a skylight and three
sides of heavy sanded glass, admitting north light. It is
finished in white, and, in order to prevent the bad effects
of glare, the surgeons wear the Mayo-Secor cap, with a
beak as described in The Modern Hospital of September,
1917. It is provided with a special ventilator to carry off
Fii;. 1. The Ke
Sanitarium-Hospital at Kr
county, is of pebble dash stucco with metal tile roof and
wide projecting eves, a very practical construction for this
climate. The inside walls are plastered with Keene cement,
enameled to 6 feet above the floor and alabastined over-
head. This allows the side walls up to 6 feet to be fre-
quently washed. The floors are of asbestone with integral
base. The centers are light tan, the borders and base are
dark red. These floors have proved very satisfactory in-
deed; they are sanitary and very easily kept in first-class
_> ffi»>^dB
l^p#lJ
^^^^^^H i m ^^^^B*^i*'^
11
1
'W r-^rmt^
*^
1 1 I
:-3
to
em^
1
1
condition. We have found that an occasional light applica-
tion of linseed oil and turpentine, half and half, followed
by a coat of paraffine dissolved in gasoline, which, when
dry, should be polished, keeps these floors in excellent
condition.
The building is heated by two hot-air furnaces so
Fig. 3. The operatiny
n-Hospital.
the ether fumes. The surgical staff of the hospital places
special stress upon preoperative and postoperative treat-
ment, and the medical staff appreciates the value of the
latest methods in therapeutics, so that the treatment rooms
are equipped with hydrotherapeutic apparatus, electric-
light bath, hot-air bath, electric vibrator, high-frequency
coil, etc.
The nose and throat department is provided with foun-
tain cuspidor, compressed air, cautery outfit, etc.
Fig. 4. A patient's
m in the surgical department of the Kerr
Sanitarium-Hospital.
The laboratory and drug room are well equipped and
presided over by a salaried house physician.
The hospital has an endowed library of over a thousand
especially selected volumes. This has proved of the great-
est value and is a source of constant pleasure to the
patients.
THE MODERN HOSPITAL
59
The building is so arranged that all surgical work is
cared for on the second floor. The first floor is devoted
to convalescents and medical cases, where they will be
away from the odors and noises incident to the surgical
department.
The whole second floor is furnished in the best grade of
white enameled steel furniture. The bedside tables have
plate glass tops with a compartment below for utensils.
The beds have attached adjustable back rests. With the
composition floors, the enameled walls, and the enameled
steel furniture, the equipment of the surgical department
makes the most efficient service possible.
In the rooms of the medical department on the first
floor, oak and mahogany furniture is utilized, hot and cold
water is provided, and an endeavor is made to make the
rooms homelike without doing violence to the essential
sanitary features.
This institution seems to us to approach the ideal in
community hospitals. It is large enough to support a
complete equipment and to make it practical to employ
competent help in every department including a house
physician, and yet not so large but that one chief of staff
can keep in personal touch with every detail. The chief
of staff is a Fellow of the American College of Surgeons,
who naturallj^ takes pride in keeping it fully abreast of
the times. It is self-supporting and provides for both
charity and pay patients. Careful records are kept which
answer the questions: What was the matter with the
patient? What was done to him? What was the end-
result?
During the past seven years members of the staff have
made a number of original contributions to both medicine
and surgery, such as, "An Improved and Simplified Tech-
nique for Autoserotherapy," "The Treatment of Pellagra
by Autoserotherapy," "Glucose Solution by Hypodernio-
clysis for the Prevention of Postanesthetic Acidosis,"
"An Improved Hemorrhoid Operation," which Dr. J. B.
Murphy said he considered a "distinct advance," and a
number of improvements in surgical instruments.
Thus it is seen that even though a hospital is isolated —
over seventy miles from a sister institution — with proper
equipment and competent men on the staff, it may not only
do the regular routine work that conies to it, but also
reach out into the promising fields of research and im-
provement. The satisfaction gained by the staff in main-
taining a standard that will produce these results more
than repays them for the effort.
Our Eastern Representative
In regard to Mr. Joseph J. Weber, who this month be-
gins his duties as Eastern representative and field editor
of The Modern Hospital, the S. C. A. A. News prints
the following:
"Joseph J. Weber, who has been the efficient secretary
of the committee on hospitals of the State Charities Aid
Association for the past three and a half years, has re-
signed to accept the position of assistant director of the
Boston Dispensary, and Eastern representative of the
magazine. The Modern Hospital. His resignation is
received with regret by the association.
"Mr. Weber brings to his new position a splendid equip-
ment of training and experience. He is a graduate of
Hamilton College, from which he holds the degrees of B.A.
and M.A. He prepared for social work at the New York
School of Philanthropy. After graduating from the
school he became director of the Civic Association of En-
glewood, N. J., and came from there to New York as
financial secretary of the Charity Organization Society, a
position which he held for two years. Since then he has
been with the State Charities Aid Association.
"Among the more important activities of the hospitals
committee while he was its executive officer have been
the following:
"The formulation of a report of a survey on sickness
in Dutchess County and the organization of a comprehen-
sive public health as.sociation in that county which is
likely to serve as a model for other counties.
"Making community surveys of hospitals in Westchester
and Washington counties to aid in the increase of hospital
facilities in both counties.
"An extensive study of the facilities in general hospitals
and dispensaries of New York State outside of New York
City for the diagnosis and treatment of venereal di.seases.
"A critical study of plans of various new hospitals in
New York City and elsewhere.
"Compiling a handbook on the care and treatment of
alcoholic and drug addicts.
"During the past year Mr. Weber's services have been
loaned on part time to other organizations for important
pieces of work. He acted as secretary of the committee
on planning and financing of municipal and nonmunicipal
hospitals of the 1917 annual meeting of the American
Medical Association and as such had charge of the or-
ganization and preparation of its first extensive exhibition
of hospital plans.
"Since April of last year he has acted as secretary of
the New York Mayor's Committee on Hospital and Med-
ical Facilities, a position he now relinquishes. This commit-
tee has assisted in important war work in connection with
the organization of adequate hospital, medical, and nurs-
ing facilities for military needs in and near New York.
"Mr. Weber has delivered addresses on health topics at
public hearings before boards of supervisors, committees
of the legislature, county medical societies, and has also
been one of the outside lecturers before students of Teach-
ers' College at Columbia. He has written numerous arti-
cles for hospital and health periodicals."
"Treat Thy Nurses Sweetly"
The following extract, taken from Jeremy Taylor's
"Holy Dying," is so quaint, so instructive, and takes such
an unusual view of the position of a patient towards her
nurse, that we are sure it will be of special interest to
our readers: "Treat thy nurses and servants sweetly,
and as it becomes an obliged and a necessitous person.
Remember that thou art very troublesome to them; that
they trouble not thee willingly; that they strive to do thee
ease and benefit, and are glad if thou likest their attend-
ance; that whatsoever is amiss is thy disease, and the un-
easiness of thy head or thy side, thy distemper or thy
disaffections; and it will be an unhandsome injustice to
be troublesome to them because thou art so to thyself; to
make them feel a part of thy sorrows, that thou mayest
not bear them alone; evilly to require their care by thy
too curious and impatient wrangling and fretful spirit."—
Nursing Mirror.
The Old Time Doctor
Out of the past that was kind and warm,
Comes, with a scent of iodoform.
Mixed with a hint of valerian.
The dignified, old-time doctor man.
Beard that is long and streaked with gray,
With smile that is grave and a solemn way.
With ear that is keen to my mottled skin
To hear what is wrong with the works within,
I felt that he got more honest dope
Than the modern man with his stethoscope.
His long-tailed coat, I can see it yet.
His calf-skin boots I cannot forget.
With saddlebags and high, silk hat, —
There are no more men in the world like that.
But out of the past that was kind and warm
He comes with a scent of iodoform.
• — Illinois Health News.
60
THE MODERN HOSPITAL
THE MEMOIRS OF A HEAD NURSE
II. Bill Black, the Best Orderly I Ever Knew— How John
Barleycorn Handicapped a Life of Usefulness
We had an orderly in the emergency service, old Bill
Black. Bill was a born orderly, and there are not many
of his kind. You know the usual lot, the floaters, the
men who have failed in most everything else, and who
work long enough to get some new underclothes and an
overcoat and have enough left for a spree. We had a lot
of these coming and going, but Bill always stuck. He
was an orderly and nothing else. Hospitals were home to
him and he couldn't exist in any other place.
Bill had been a British soldier — had served his time in
the army in India — and he knew more about treating heat
prostration cases than the staff and the interns all put
together. I'll never forget one summer we had in D.,
when there had been a horrible heat wave that lasted
several weeks. The temperature in the operating amphi-
theater under the glass roof seldom went below HO or 115
in the middle of the day. Every once in a while a nurse
would topple over, and we fed everybody cool drinks
through glass tubes put through their masks while they
were operating.
The police ambulance kept up a steady run. Most of
the patients were teamsters or street laboj-ers or kitchen
workers, unconscious with heat; later on their temperature
would run up toward 107, and they would go mad. It was
then that Bill would get in his good work, and we would
have to lend him to the men's wards, with another little
Englishman we had who had seen service in India. The
staff men and the interns would leave their orders in the
ward and tell the head nurse to "leave it to Bill."
I'll never forget how Bill and his pal worked over one
giant teamster, who had been brought in unconscious and
with a temperature so high that you could not believe
the thermometer. He had become so wild that they had
to strap him in bed, and when Bill was called in council
the staff man who had the case said the patient was a
goner if the temperature didn't come dowTi, and he didn't
think it would with that powerful maniac fighting treat-
ment the way he did. But, fortified with four ice-caps,
four hot-water bags, a foot-tub full of cracked ice, plenty
of sheets, an electric fan, an enema can, and a long feed-
ing forceps. Bill started in. With the assistance of three
interns and the other orderly he succeeded in giving the
patient a cooling enema, and wrapped him in cold wet
sheets, underlaid with plenty of tightly fastened rubber
sheeting, ready for the coming battle. And battle it was,
this maddened giant and death on the one side, and Bill
and the other orderly, Harry Carnes, fighting for every
inch of ground on the other. On went the electric fan.
"Full speed, 'Arry," said Bill, then with both hands
full of crushed ice Bill would go over the wet-sheeted body
, of his patient, talking all the time as you would talk to a
sick child or a horse that had been frightened. "Steady
boy, take your drink now; that's the lad; try it again."
And 'Arry was using any spare time he had when not
sitting on the patient to keep him down, to feed him
pieces of cracked ice on a long forceps. Then the tide
would turn, and Bill would call out, " 'Is 'ands and feet is
too cold; come on with yer 'ot-water bags; ofi' with yer
fan, she's eomin' down too fast; quick 'ere with yer dry
shirt."
And so, sometimes for hours, they would fight the fever
until they had conquered it. And when the patient, weak
as a kitten, but sane and saved, would fall into a natural
sleep. Bill would say, "Come on, 'Arry, I guess 'e's safe
now to leave to the doctors." Then the men would saunter
back to their work, soaked to the skin, and gray faced
with exhaustion, but smiling and content with the victory
won.
Every two months or so Bill simply had to get drunk,
never on duty, however, as a rule he didn't lose any time
by it, but gloriously drunk he had to get, and in their
attempt to get him to bed and save his job for him, some
of the other orderlies usually wore a black eye and numer-
ous bruises after each of these occasions. Once in awhile
he would have to lay off the next day, and then the details
of Bill's last offense would get to Dr. B:, the superintend-
ent, and Bill would be fired. Dr. B. would pound his desk
and say, "Now this is the last time, nobody need ask me
to take him back again, because I won't do it; he's a
disgrace to the place. Never again."
Well, in a day or so there would appear a very humble
and contrite Bill. He'd sneak up to the superintendent of
nurses or the operating supervisor, and twirling his hat
in his hands would begin the same old question. "Do you
think, now, if maybe you would talk to the old man,
maybe I might get another chance?"
The operating room supervisor would say, "I don't
know. Bill, here you left me on a big clinic day, with
thirty major operations and all the p61ice ambulances in
the city rushing in wrecks, and the other boys trying to
do all the work alone, and the only help I could get a dub
of a ward orderly who didn't know the morgue litter
from a stretcher cart — but you wait around down in the
basement, I'll see the doctor and see what I can do."
And then the following dialogue would take place in
the front office, after the supervisor had gone down, ap-
parently for something else entirely, and during the course
of a conversation begun on an entirely different subject:
O. R. Supervisor: "I'm having a pretty hard time with
the orderly question upstairs."
Superintendent: "That so? What's the matter?"
O. R. Superintendent: "You know we are having an
unusual rush up there now, and there is more than the
two men I have can do."
Superintendent: "Well, can't you get another one?"
O. R. Supervisor: "Oh, yes, I've tried two or three
ward orderlies, and none of them are any good. [Long
pause.] I wish we could get Bill back. He can do two
men's work, and he knows as much about the service as
I do."
Superintendent: "That , I'll not have him in
the building."
O. R. Supervisor: "But you know that there is to be
a big celebration in the city next week, and there will be
crowds and a lot of accidents, and "
Superintendent: "Oh, well, you women will get your
sympathies worked up. If you really need him, go get
him; I suppose he is hanging around somewhere."
O. R. Supervisor: "Thank you, doctor, I think I can
find him."
And the word flies to the basement that "all is well."
The first hospital exclusively for desperate cases, oper-
ating as a field unit, is an American medical corps hos-
pital within range of the enemy guns in Picardy, says a
press dispatch. Pour American nurses there probably are
working closer to the front than any other women in the
entire allied lines. Unworried by air raids and bombard-
ments, their only concern is that "the gas masks are too
big for our noses."
THE MODERN HOSPITAL
61
VISITORS AND VISITING IN HOSPITALS'
The Problem in the General Hospital — Desirability of
RestrictinR \'isitinK- in the Wards — Less Protection
Required for Private Patients — The Varying
Problems Presented by Special Classes
of Hospitals
Bv JOSEPH GEFFEN, Superintendent Mount Sinai Hospital,
Philadelphia.
Conditions vary to such an extent in different hospitals
as to make it impractical to lay down set rules concerning
visiting and visitors. In the course of an extended inquiry
and investigation, the fact was clearly disclosed to me
that the rules and regulations governing the admission of
visitors to patients undergoing treatment in hospitals are
so nearly alike as to lead one to believe that practically
all have been copied from one and the same model, and
that, by some tacit understanding or misunderstanding, it
has been agreed upon that none should introduce a change
even though all will unhesitatingly agree that changes for
the better in that direction are sorely needed.
I was, therefore, prompted to wi-ite this paper, not
because I can individually bring about radical changes or
revolutionize the field, but in the hope that universal dis-
cussion may bring about certain changes, and ultimate
betterment to justify this humble effort.
All will agree that hospitals are first and foremost for
the treatment of the sick, but since the question of visitors
and visiting is so closely interlinked with the care of pa-
tients in the hospital, the problem becomes very complex
and calls for extraordinary judgment to determine if visit-
ing can be entirely eliminated, and if it would serve the
best interest of those who should receive our primary
consideration, or if it can be partly mitigated by striking
the happy medium. Due consideration of this subject,
however, makes it clear that total elimination of visitors
is neither practical nor possible. First, it has been proved
that the mental anxiety of the patient, because of total
absence of visitors, would be a retarding factor in the
progress towards recovery, and secondly, even w^re this
not the case, public opinion, upon which every institution
so greatly depends, would be hopelessly against it, not
only to a point of withholding financial support, but to a
point of impairing the institution's usefulness, for it is
safe to say that few would enter our wards with the pros-
pect of being utterly secluded from their relatives and
friends. Admitting, then, that visitors must be permitted,
we will confine ourselves to the discussion as to the way
in which it can best be done and how we can best serve
the interest of both the patient and visitor.
THE GENERAL HOSPITAL
The Wards. — Undoubtedly the greatest problem of visi-
tors is encountered in our large general wards; we are
often obliged to refuse visitors to a patient whose con-
dition is such that visiting would be detrimental to him,
and yet all around this very patient are visitors whose
loud speaking and commotion is often more unbearable
than would be a relative who perhaps would be content
to stay only a few minutes. It is true that, when possible,
patients in a serious condition are removed during visiting
hours to some room provided for that purpose, or a screen
placed around the patient, but the former is not often
possible or practical, because by removing him the patient's
suspicion is aroused and unduly excited, and to place a
screen around the patient is overcoming the difficulty to
a very small extent. It would, therefore, seem advisable
to restrict visiting to the general ward patients as much
as possible and practical.
Length of Visit. — Most institutions permit visitors to
the general wards three or four times a week, and allow
them to stay from two to four hours, thus causing an
unrelieved strain upon the patient. While conditions im-
pose upon us the necessity of allowing vi.sitors three times
a week, it does not appear to be absolutely necessary that
the time for visiting be prolonged to the period generally
allowed. I feel that the reduction of time limit to one
hour would serve the best interest of the patient and at
the same time would cause less inconvenience to the institu-
tion. Let us consider the practicability of the one-hour
limit and the benefits that would accrue therefrom.
It is quite obvious to anyone familiar with those visiting
patients that the object of their visit is based chiefly on
their anxiety about the patient's physical welfare. The
conversation, therefore, should naturally be confined to
that subject, and, if the average visitor would limit him-
self to the essential questions that are the purpose of this
visit, it would not be necessary for any one visitor to stay
more than fifteen or twenty minutes, thus affording an
opportunity for at least three friends to visit during the
hour, even though only one is allowed at a time, and at
the same time minimizing the danger to the patient caused
by unnecessary talk of visitors who have more than the
above-mentioned time at their disposal. It is a fact that
the more intelligent usually make their visits to the sick
very brief. Viewing the question from a material point
of view, we cannot disregard the inconvenience caused by
suspension of many activities, both medical and institu-
tional, for a duration of two or more consecutive hours.
Number of Visitors. — The question how many should be
permitted to the bedside at one time and the number that
should be allowed during visiting hours is quite worthy
of our consideration. Most hospitals permit too many
visitors to see patients during visiting hours. Very often
as high as twelve people will visit one patient. This
custom does not serve the best interests of patients because
this constant stream of visitors is too great a strain not
only upon the patient visited, but also upon those in the
same ward. There seems very little reason why more than
two or three people should be allowed to see a patient in
one day. Further to minimize the patient's discomfort,
would it not be advisable to allow only one visitor at a time
to the bedside of the patient, thereby relieving the patient
of the strain of having to listen and talk to two at one
time, which is often the case under the present system?
Furthermore, it would reduce the noise created by the visi-
tors, since only half the number would be in the ward at
one time.
Visiting Hours. — Most institutions confine their visiting
hours to the day time. This, I believe, is an injustice to
the relatives of the sick, because, when visiting is permitted
during the day hours only, there are many who must be
either deprived of the privilege of seeing the sick or com-
pelled to leave their work; hence it would be advisable to
make one visiting hour in the evening. I am fully aware
of the fact that the sick are usually worse at night, and
for that reason visiting should be confined only to members
of the family who cannot come at any other time. Some
are against night visiting on the grounds that ther-e are
iewer nurses on duty at night and therefore there will be
less supervision; on the other hand, while a greater num-
ber of nurses are on duty during the day hours, those
62
THE MODERN HOSPITAL
nurses are just as busy and have no more time to devote
to visitors, so this objection has very little vv^eight.
Private Wards. — The problem of visitors reduces itself
in proportion to the decrease in the number of patients
in a given space. This is why we find it more practical
to allow a greater latitude to visitors in private wards.
However, a one-hour daily visit should be sufficient.
Private-Room Patients. — In dealing with the private-
room patients the problem is very easy of solution, since
those visiting private rooms do not interfere with the wel-
fare of any other patient. Therefore, visitors can be
allowed nearly all day. The only thing that should be
required of those visiting private patients is that they
should be obliged to inquire in the office before going to
the room of the patient; and, if for any reason the patient
does not care to receive visitors or his physician has
ordered that none be permitted, it will be but a simple
matter to keep visitors out.
SPECIAL HOSPITALS
Children's Hospitals. — There are, of course, certain
well-defined disadvantages to the visiting of children. The
danger of transmission of contagious diseases has not
only been attributed to visitors, but, in some cases, has
been fairly proved. We all know that as soon as the child
sees its parents it begins to cry and will often continue
the performance until some time after they leave. This
condition is by no means a healthful one, very often being
the cause of rise in temperature and a feeling of home-
sickness and restlessness. Furthermore, we cannot .over-
look the danger of food being smuggled in and given to the
children with ill effects; in short, there is little room for
doubt that visiting is practically always detrimental to
the physical welfare of the child, and yet, with all its
disadvantages, I doubt whether we can exclude parents
from visiting their loved ones. From personal experience
in a hospital that does not permit visiting to children, I
know that, when the mother is told that she will not be
permitted to- visit the child, in many cases the patient was
either taken to another hospital or cared for at home.
Furthermore, a feeling of resentment will be engendered
against such a hospital and its usefulness will to some
extent be curtailed. We can and should, however, in jus-
tice to the patient, limit these visits to once or at most
twice a week. No one should be permitted to enter the
children's ward without putting on a visitor's gown, pref-
erably the kind that is slipped over the head and very
long, making it somewhat difficult for the visitors to use
their hands.
Maternity Hospitals. — Visitors to maternity cases should
be treated in much the same way as those in hospitals
for communicable diseases. The most rigid asepsis should
be observed by the use of caps and gowns and under no
condition should visitors be permitted to touch a parturient
woman, either before or immediately after confinement.
On account of the nervous condition of the patient for at
least twenty-four hours after confinement, visiting should
be restricted to mother or husband of the woman; some-
times, owing to infection or other complications, it may
be wise to continue the restriction for a longer period, but
in the ordinary case, the sooner a woman is permitted to
see those who are near and dear to her, the more rapidly
she will recover her normal spirits. Under no condition
should the visitor be permitted to handle the infant.
Hospitals for Contagious Diseases. — It is a fact that
many children suffering from a contagious disease are
treated at home for the sole reason that parents prefer
to be isolated with the child and are willing to undergo
hardships rather than send the child to a hospital in which
the patient cannot be seen, except the patient be in a
serious condition. But since these hospitals until the
present have not yet given due consideration to visiting by
building the institution in such a manner as to make it
possible for visitors to see the patient without coming
into dangerous contact with them, there is little room to
doubt the wisdom of excluding visitors. In Germany some
hospitals for contagious diseases have so built their institu-
tions as to make it possible, by means of glass partitions,
for visitors to see the patients without coming into contact
with them. It is hoped that our institutions will adopt
some similar plan of architecture providing for visiting
to this class of patients without danger of contact.
Tubereulosis Sanatoriums. — Tuberculous patients in
sanatoriums, being as a rule physically fit to walk about
and mentally alert, will naturally dwell upon their afflic-
tion, which most certainly will have a deleterious effect
upon their vitality. It would, therefore, seem to be advis-
able to encourage visitors as frequently as would be prac-
ticable, in order to divert the mind of the patient from
his illness. But considering the nature of the disease, par-
ticular care and supervision should be exercised over these
visitors. It is a familiar fact that these institutions, unlike
hospitals, usually cover a large area, and if its visitors
be permitted to meet patients all over the grounds, as is
often the case, there is more harm than good to be ex-
pected to both patient and visitor. For instance, unless
closely watched, a visitor in his ignorance may smuggle
in to the patient food that is strictly forbidden; on the
other hand, out of great solicitude, the visitor himself,
being blind to the danger of close contact, will sometimes,
upon leaving, kiss the patient.
VISITS OF OUTSIDE PHYSICIANS
In some hospitals with closed staffs there is clearly
indicated a desire on the part of the management either
to exclude outside physicians as visitors or so to surround
their admittance with red tape as to cause them the great-
est amount of inconvenience. Frequently the rules prohibit
outside physicians from visiting ward patients unless ac-
companied by the intern. It is, of course, a courtesy to
detail a house physician, but to prohibit the visitor enter-
ing the ward without the intern is very annoying and
certainly does not inculcate a spirit of respect for or
cooperation with such a hospital. It should be remembered
that the family physician is often the family advisor and
that, even though his professional skill may not equal that
of the hospital staff, he is in a position to either help or
hai'm the hospital by either favorable or adverse crit-
icism. The best and most lasting results to the patient
can be attained only by coopei'ating and consultation with
the family physician of free patients, and even by the
further expedient of permitting him free access to the
hospital whenever he desires to enter. He should also be
permitted to inspect the clinical charts; the refusal ^
grant such rights can only be considered as an admission
that the records of the case are incomplete or that the case
has been carelessly reported. Then, again, the hospital is
performing one of the most important functions by allow-
ing the outside physician to study the records of medica-
tion and treatment; it assists in the education of the
doctor.
REGISTRATION SYSTEM
Much depends upon the size of the hospital and the num-
ber of visitors allowed to one patient in determining the
best method of handling and controlling its visitors. Hav-
ing studied the workings of many systems, I am led to the
THE MODERN HOSPITAL
63
conclusion that the best method, and one suitable for
almost every institution, is one adopted by the Michael
Reese Hospital of Chicago and described in The Modern
Hospital, which is the following:
A board is set up at the desk in the main hall, where
visitors must receive their credentials before going into the
hospital proper. On this board are figures representing all
the wards of the institution, and beneath the number of the
ward are small pockets made of vulcanized rubber or some
such material, the number of pockets for each ward cor-
responding to the number of beds in the ward, and in each
of these pockets are three cards; one projects above the
other two and contains merely the name of the patient
occupying the bed. In front of this name card and a little
shorter, so that they do not hide the name, are two other
cards, the regular visitors' cards apportioned to the pa-
tient wi-itten lightly in lead pencil so that it can be easily
erased for use of the card elsewhere. It is the pi-actice
to allow two visitors only at one time and w-hen the two
cards apportioned to the patient have been distributed
to visitors no other visitor can see the patient until the
cards are again returned to the board, as evidence that the
visitors have gone. If it is ordered that the patient shall
have only two visitors during the day, the cards will not
be returned to the rack until night. If the patient can
have as many visitors as choose to call, the cards are
immediately returned to the rack on their surrender by
visitors as they leave, and they can be given out to other
visitors. Sometimes, by the order of the doctor, the pa-
tient is not to have any visitors at all, and in such case
a note to that effect is stuck in the pocket against the
patient's name, so that visitors may be refused when they
present themselves. Sometimes it is necessary for the
business office to see the friends of the patient for financial
or other reasons, and in that case a note to that effect is
slipped into the pocket against the patient's name, so that
if anyone calls to see the patient he can be sent to the
office; or perhaps it is the house physician who wishes to
see the friends of a patient to present some problem or
make some announcement, and the note in the pocket will
request that the house physician be sent for when a visitor
comes.
There is no doubt that it is the desire of the management
that all visitors should be treated with every courtesy and
consideration, but I doubt whether this hope is fully
realized, because the duty of handling visitors is usually
delegated to a young clerk who possesses very little judg-
ment and is usually not overfilled with the milk of human
kindness. The success or failure of the handling of visi-
tors is not so much the system as it is the individual in
charge. There are few, if any, more important duties
than the handling of visitors, since it is the best means of
establishing a friendly relationship between the public
and the institution. A kind word will often do more to
establish the reputation of the institution than the best
medical skill. It is, therefore, advisable to choose care-
fully the person to whom to entrust this most difficult duty.
In my opinion a senior nurse or even a graduate would
best be fitted to take charge of the visiting desk. Not
only would a nurse be able to understand more intelli-
gently the doctors' orders in order to transmit them to the
visitor, but her uniform itself places her in a position to
command respect, which the average clerk would find it
very difficult to get. Furthermore, a nurse could become
intelligently informed regarding the condition of the pa-
tients, and, in the event that the resident physician is too
busy to answer questions of the anxious relatives regard-
ing the condition of the patient, the nurse undoubtedly,
with the physician's approval, could readily act as his
substitute with entire satisfaction.
LOOKING FOR BRICKS
The Children's Home at St. Anthony, Nowfouiidhmd— A
New Building Badly Needed for New-
foundland Orphans
When Dr. Grenfell found little children along the
Labrador suddenly orphaned, without relatives or friends
to take care of them, he set to work speedily to build
them a home. He built them the best home that could be
built, with the materials at hand. Unseasoned lumber
had to be used because there was no other; the building
Fig. 1. Nine-year-old Tommy Shuglo. who cHme to the Children's
Home when four years old. Though very delicate and often sick
\vhen he first came. Tommy was such a pet that his favorite ex-
pression was. "I lilies everybody, I do."
season is short in Newfoundland, and the children were
waiting. Before long there were more children waiting
and no room for them, so in the midst of many other in-
terests and needs, additions were swiftly built to the
original home to shelter the homeless. For fourteen years
the children have found there a welcome so warm and a
Trrfc-f ■ iv
Fig. 2. The pre
home at St. Anthony, Newfoundland.
care so constant and tender that they have grown well
and happy. The house is getting old and draftier, and
more inconvenient to repair. A new home, which must
be of brick, is badly needed. Each brick costs twenty-five
cents by the time it is laid at St. Anthony, and the send-
ing of twenty-five cents for one brick entitles the sender
to membership in the Grenfell League and to a Grenfell
League button. Contributions may be sent to Miss S. E.
Demarest, 156 Fifth Avenue, New York.
You will confer the greatest benefits on your city, not
by raising its roofs, but by exalting its souls. For it is
better that great souls should live in small habitations
than that abject slaves should burrow in great houses. —
Epictetus.
64
THE MODERN HOSPITAL
Who Should Be Dispensary Patients?*
By MICHAEL M. DAVIS, JR., Ph.D.. Director, Boston Dispensary,
Boston, and ANDREW R. WARNER. M.D.. Superintendent.
Lakeside Hospital. Cleveland.
There is a hoary misconception concerning the mean-
ing of "charity." Formerly it was generally conceived as
a dole to the destitute. Unless the recipients were unable
to make any return except in gratitude, the gift was hardly
charity at all. But the modern conception of charity is
not a dole, but a service — a service rendered by an individ-
ual, an organization or a community to persons or groups
who could not otherwise obtain the benefit provided.
Ability to obtain a benefit depends partly on the in-
come or opportunities of the recipient and partly on the
cost of the thing to be obtained. Now the cost of medical
service supplied by dispensaries has changed greatly since
the early dispensaries began their work, and especially
during the last fifteen years.
The old dispensaries provided merely the advice of a
single physician and medicine. They corresponded to the
general practitioner before the days of modern scientific
methods of diagnosis. The modern dispensary provides
varied and expensive services, and what it offers its pa-
tients is to be compared not only with the service of the
general practitioner, but with that of the specialist, the
laboratory, or the x-ray man.
A very little consideration of the cost of treatment of
different diseases shows within what wide limits this
ranges. A minor illness might require a couple of office
visits to a general practitioner and a little medicine. All
this might cost a patient $2.50 or $3.50.^ A case of "indi-
gestion" requiring several examinations, x-ray and care
for a considerable period might cost, at a low estimate, $75
for the first six months. A case of syphilis requiring s^l-
varsan injections would cost over $100 for the same period.
Examinations of the nose and throat by a specialist and
operation for a deviated septum, with the necessary after-
care, would cost $50 or over. Examination of the eyes by
an oculist, with provision of glasses not unusually expen-
sive, would cost $10. The supervision of a little baby
subject to digestive upsets might cost $40 to $60 within
six months. The diagnosis and supervision of a case of
adult tuberculosis at home would cost $25 to $30 during
the same period, not including the expense of special food.
Complex conditions requiring examinations by a number
of different specialists, x-rays, and various laboratory tests
might cost $100 or $200 before the diagnosis was reached.
Thus the test for the charitable dispensary is not the
ability of the patient to pay "a medical fee," but to pay
the medical fee required for his particular case at the
usual rate charged by compet-ent doctors in his commu-
nity. In other words, cost of service needed, in relation
to the financial ability of the patient, is the real test.
The broadening of the range of dispensary service med-
ically has thus greatly broadened its scope with respect to
the economic classes in the community. The widely vary-
ing kinds of medical and surgical work which now can and
should be done, and their widely varying cost, explain
why even the charitable dispensary cannot confine its work
to any particular economic and social group at the lower
level of the community. The higher paid wage-earners
and the small-salaried groups need its services, particu-
larly in the specialties and in difficult cases requiring
elaborate consultation and special tests.
The more developed the medical organization of a dis-
*Extract, reprinted by permission of The MacMillan Company, from
a forthcoming boolc on "Dispensaries ; Their Organization and Manage-
ment" by the authors above named.
lit win be obvious that these statements of medical cost are merely
illustrative. They are based on what physicians or specialists would
probably charge patients known to be of very moderate
pensary is, and the higher the reputation of its medical
staff along their various lines, the more surely and the
more justly will this institution draw patients from va-
ried classes in the community. Many of the patients may
be able to afford ordinary medical fees, but need, and feel
they ought to have, special service which they could in
no way afford to pay for at private rates. This considera-
tion applies particularly to the teaching dispensary at-
tached to a medical school of high standing. Such a dis-
pensary may well fill more than a local position as a cen-
ter for diagnosis and consultation as well as for treat-
ment.
FEES FROM DISPENSARY PATIENTS
The antiquated conception of charity to which we have
referred is responsible for another misconception, namely,
that the services of an institution like the dispensary must
be rendered without price. There still exist those who
wish to give their charity straight; those who see no dis-
tinction between the medical service provided by a hos-
pital or dispensary and the pair of shoes or "grocery or-
der" furnished by a relief society. The gradual passing of
this point of view is evidenced by the fact that a ma-
jority even of the charitable dispensaries of this country
now charge small fees for admission, treatment or medi-
cine, or for one or all of these. There has been, however,
little discussion of the economic and moral foundations of
the fee system in dispensaries.
It is obvious that, whether a dispensary is founded
as a charity, for teaching, or for public health service, it
must not charge a fee based merely upon the cost of the
service rendered, for in many instances this fee would be
too high to help many of those who need it, and the in-
stitution would thus defeat its purpose of service. On the
other hand, practical experience of dispensaries, as well as
an unprejudiced consideration of human nature, bears out
the belief that those who pay something, even ten cents,
for what they receive take advice or treatment more seri-
ously and feel rather better about accepting the service
than if they paid nothing. Most people are built this way.
Some are different. The dispensary fee system, however,
is justly based upon the psychology of the majority.
There is another point of view, namely, that services
like the dispensary, providing health for the people, ought
to be supported by general taxation and be free for all
citizens. Whether or not this point of view is sound,
most will agree that until medical service is a state func-
tion (if that day comes), a dispensary, as a form of medi-
cal service, ought to conform, in the general principles of
its operation, with the general system for providing medi-
cal service in the community. From this standpoint there
is no reason why dispensaries may not, on the one hand,
be private enterprises like the Mayo Clinic, or, on the
other hand, be charitable institutions. They correspond
in the one case to a private school, in the other case to
an endowed college. In either instance there is no reason
why they may not charge fees.
What shall be the relation between the patients of a
physician in a dispensary and in private practice? Should
patients who can pay the usual private fees for the needed
medical service be treated in a dispensary free, or for
nominal fees? If such persons apply at a dispensary for
treatment, shall they be referred to private physicians, and
in particular to the staff of the dispensary itself? What
shall a physician do when a patient in the clinic seems to
be in sufficiently good circumstances to pay private oflice
rates ? For the protection alike of patient, physician, and
dispensary, it is necessary to establish a policy and devise
a procedure by which the selection of patients able to pay
THE MODERN HOSPITAL
65
private fees shall be made by the dispensary, and the pa-
tients themselves be referred in a manner which will be
likely to insure them good medical treatment, be just to
the medical profession, and beneficial to the community.
The policy which should govern the situation may be
set forth in a few simple rules:
1. A charitable dispensary aims to provide the best med-
ical treatment for those who cannot otherwise secure it.
It aims not to accept patients who can aflford to pay the
usual private rates for the medical care which they re-
quire.
2. The admitting officer of the dispensary, under its su-
perintendent and trustees, should be responsible for de-
termining the circumstances of the patient and, after
consideration of the patient's income, family responsibili-
ties, and the probable cost of the medical "treatment re-
quired, for deciding whether the patient should be treated
in a free clinic, a day clinic, or in the private office of a
physician.
3. The reference of the patient to the proper agent for
treatment should be made by the admitting officer, or
other administrative official of the dispensary, not by a
member of the medical staff.
4. Due records should be made of each case thus re-
ferred for treatment outside of the dispensary.
5. No physician should solicit private practice from pa-
tients.
In carrying out such a policy effectively, the chief
requisite is a well-organized admission system, under a
competent head. Most of the difficulties which arise are
due to a lack of this. The medical staff must be fully in-
formed of the policy. They should understand that, should
a patient appear in a clinic whom a physician thinks has
not been properly judged by the admission desk, the pa-
tient is to be sent back to the admission desk for recon-
sideration and further reference. The question then arises,
to whom shall the admission desk refer a case needing
private treatment? In general, it seems just that such a
patient be given the names of one or more members of the
staff of the clinic to which his disease would naturally as-
sign him. Cases also arise in which the patient asks at the
admission desk for the name of a competent doctor, or
himself solicits a physician, in the clinic, for private
treatment. When a patient does this the physician should
report the fact to the admission desk, or to the repre-
sentative of the admitting officer in the clinic (the social
worker, nurse, or clerk). The admitting office or its repre-
sentative will then refer the patient to the physician, but
due record will be made of the fact upon the patient's
record card and elsewhere. Solicitation of private practice
by physicians in clinics should be regarded by the admin-
istrative authorities of the dispensarj' and by its medical
staff as seriously unprofessional conduct.
What shall dispensary fees be, how much and how de-
termined ? They should clearly follow the traditional
ethical rules of the medical profession, "not refusing serv-
ice to anyone really needing it, whether the fee levied can
be paid or not." But how shall the general level of the
fees be determined, understanding that partial or com-
plete remission of fee will always be made in suitable
cases?
In private medical practice the fee received by the
physician is partly a compensation for his medical service
and partly payment for the expenses he must meet in
maintaining his office, his assistants, his equipment, au-
tomobile, etc. In the medical institutions the appliances,
instruments, laboratory, nursing, etc., are provided for the
doctor. When a dispensary not organized for profit does
not pay its physicians, it may charge fees not averaging
more than the cost of the services rendered, excluding any
charge for the medical service as such. Were this princi-
ple strictly carried out, the physician giving his time in
the dispensary would receive no money, and the fee paid
by the patient would no more than meet the strictly ad-
ministrative expenses. These, on the average, would be
less than those requii-^d to maintain an equivalent medical
service in a single private office.
If fees at a dispensary are on the average higher than
the administrative costs, then the clinic becomes a pay
clinic and the amount of the fees received above the ad-
ministrative costs should go to the medical profession,
either directly in salaries to the staff, or in some fashion
approved by them for the advancement of medical science
or medical education. In practice the usual rates of fees
in the charitable dispensaries of this country at the pres-
ent time cover from one-fifth to one-half the administra-
tive cost
SUMMARY
The principles outlined above may be summarized as fol-
lows:
1. With the widely varying cost of different medical
serWces at the present time, and the complex character
of our population and its needs, the clientele of the dis-
pensary should not be confined to the "poor," or to any
single social group.
2. Who, then, should be dispensary patients? Those
who need dispensary service and cannot secure equiva-
lent medical service otherwise.
3. Remuneration of dispensary staffs must accompany
extension of dispensary service above the low income
levels of the population.
4. The regulations for admitting patients, the fees for
treatment, and the compensation for those who do the
work must be thoughtfully adapted to each of the particu-
lar groups in the community who need what the dispen-
sary has to offer. An efficient administration of the dis-
pensary according to these policies will confer benefit upon
both the public and the medical profession.
Special Courses for Teachers and Supervisors of Nurses
Offered by New York Department of
Nursing and Health
The New York Department of Nursing and Health, to
meet the increased demand for teachers and supervisors
of nurses, has arranged a special group of courses for
the summer session. While the course is brief, it is be-
lieved that graduate nurses, who have a good educational
foundation and have showed an aptitude for teaching, will
derive considerable benefit from the work gi%'en. Those
nurses who are particularly suited for teaching can give
no greater contribution to their country now than by
making themselves ready to teach and train others in the
work of caring for the sick.
The department asks that superintendents of training
schools cooperate to the extent of looking about among
their graduates in order to find those who have had some
previous teaching preparation or experience, and endeavor-
ing to interest them in the courses offered for the summer
session.
The total cost of the course, which extends from July 7
to August 16, is usually about .$120 to $150. This includes
living expenses.
Oklahoma state institutions are making special efforts
to save flour, beef, pork, and sugar, and thirteen hospital,
asylums, penitentiaries, and colleges report to the state
federal food administrator monthly savings of 31,100
pounds of flour, 19,600 pounds of beef and pork, and
5,750 pounds of sugar.
66
THE MODERN HOSPITAL
WAR TIME
INSTITUTION
ECONOMIES
THE CONSERVATION OF GAUZE*
A Measure of Patriotism as Well as of Economics — Pro-
cess of Washing: — No Special Machinery or
Equipment Required
By NELL SHILT, R.N.. Supervisor of Surgical Supplies, Lakeside
Hospital. Cleveland.
One of the greatest questions that confronts the hos-
pitals of today is the conservation of gauze. If we do
not economize, we shall soon be called upon to use a sub-
stitute. Why not put that day off as long as possible by
washing all gauze? This has been done for the past ten
years at Lakeside and has proved entirely satisfactory.
No special machinery or equipment is used, and no spe-
cific equipment. Every hospital has all that is required.
No large amount of the used gauze is necessary to make
the process pay. Any hospital will profit thereby.
In Lakeside all gauze whatsoever is washed and again
put into use; gauze soaked with pus goes through the
same process as gauze from clean wounds. All soiled
gauze is placed in net bags hung in ordinary garbage cans
by turning the top of the bag down over the top of the
can. An effort is made to keep the gauze moist to pre-
vent the setting of the blood pigments. These bags are
collected in the afternoon. The string threaded through
the top is drawn and tied and the bag transferred to the
collecting can. The gauze is washed, sterilized, and re-
turned to the supply room in this same bag. The soiled
gauze is therefore not handled after being taken from the
wound. The process of washing the gauze is the fol-
lowing:
The gauze, after being collected in the afternoon, is
taken to the laundry and at the end of the day's work it
is put in cold water and soaked for the night in one of
the regular washers to prevent staining. In the morning-
it is rinsed through four or five cold waters with sufficient
washing soda to make the water distinctly alkaline, then
washed for twenty minutes through hot suds containing
chloride of lime, and next through hot water with erusto
salts or some substitute for oxalic acid for bleaching, then
given another hot water and two water rinses. Next it
is extracted and put through the autoclave for one hour
at 20 pounds pressure, then returned to the supply room,
and from here delivered to the public wards to be pulled
or straightened out and sorted. It goes through the entire
renovating process without being removed from the origi-
nal bag in which it was collected. After pulling it is re-
turned to the central supply room. Here it is sorted. The
articles used in the operating rooms are returned to be
prepared for sterilization by the operating room nurses.
The tapes and articles used in operations can be put
through the drying tumbler, which will take off most of
the lint, or after being taken to the operating room can
be brushed with a stiff brush, so that they are absolutely
free from lint.
In the supply room loose gauze is sorted for the various
dressings, wrapped in double linen covers, and placed in
the drier over night to become thoroughly dry. Perfectly
dry gauze comes out of the sterilizing process much dryer
than gauze even slightly damp. It is then put through the
autoclave over 20 pounds' pressure for thirty minutes
and 15 inches vac. for fifteen minutes. The fact that the
washed gauze goes through the autoclave before it is
handled at all has removed all objections to working with
it on the wards or in the central supply room. Bacterio-
logical tests have always proved it sterile.
In washing, the edges of the gauze fray and ravel badly.
This means constant shrinkage and loss. To avoid this,
as much gauze as possible is used in permanently made
dressings. These are made in two sizes for hot dressings,
a 10-foot narrow roll for neck and stump dressings, oper-
ating tapes, dressings, etc. Since we began using a large
part of the gauze so made up into special articles, the
work of pulling and sorting the gauze has been reduced
one-half.
The new gauze is issued only through the central supply
room and given out only when there is no suitable washed
gauze to issue. Operating sponges are opened, and those
in good condition reissued to the operating room. All new
gauze is cut in the central supply room in sponges of
standard sizes or in pieces of suitable size for the article
desired. Whole bolts of gauze are not issued uncut. The
sewing into made articles is done in the sewing room by
machine.
The following table gives the amount of new gauze
issued compared with the gauze actually prepared and
sterilized in the central supply room. There is also given
the ratio between these, which represents the average
number of times the gauze is renovated and used:
Average number
New gauze Total gauze times used
1915 56,400 461,230 8
191B 53.700 491,076 9
1917 28,153 441,020 15
The 1918 figures will show a distinct saving over the
1917 figures.
CONSERVATION OF DRUGS AND OTHER SUPPLIES
Vancouver General Hospital Inaugurates an Economy
Campaign — Economy Committee and Economy
Officer Do Good Work
;neral
"This is a time of economy and conservation." The
Vancouver General Hospital used the foregoing as a basis
for a conservation campaign two years ago. Since it is a
large institution in which 78 percent of the patients in
the public wards did not pay anything towards their main-
tenance, naturally a deficit was accruing. In addition,
there was a constant increase in prices of all articles
purchased.
The first step was the appointment of an "economy com-
mittee" whose duty it was to investigate every department
of the institution with a view to checking waste and effect-
ing economies, but maintaining or increasing efficiency.
The committee carried on its work vigorously, and other
members of the board, not on the committee, were privi-
leged to attend any of the meetings. It thus served the
further purpose of familiarizing them with the details of
the various departments. Meetings were held twice a
a month and at each sitting took up one department or
THE MODERN HOSPITAL
67
another, with the head of that department present. Right
here I might say that this procedure had a couple of ad-
vantages that we did not realize at first, namely, it in-
creased the interest of the head of the department in his
work and it gave the committee a chance to estimate just
how efficient their employee was. After two years of
persistent efFoi-t, we can truly say that there has been
"economy with increased efficiency."
Six months ago we went one step further and appointed
an "economy officer." It is one of his many duties to
make a daily inspection of the institution for waste and
to report it to the heads of the departments, who must
take action. All garbage cans must be inspected before
being emptied. A careful check on this, as well as many
other things, has shown splendid improvement.
The introduction of the bedside selective service of
food for all bedridden patients not only pleases the pa-
tient but saves a lot of food. From the food-carrier the
patient is served at the bedside, and in so doing his
or her tastes are consulted. Small quantities are
served, but orders are repeated on request. The food
service is quicker and far more satisfactory. During the
first six months a conservative estimate was made and it
was found that there was a saving of approximately 20
percent over previous systemfe and there were fewer com-
plaints. The containers are taken back with the remain-
ing food untouched and the plates usually come back clean.
Special food-carriers were made locally for this work.
The only complaint that we have received was a protest
from the Chinaman who contracts for the garbage, inas-
much as his supply was somewhat reduced.
Recently we have taken up the question of conservation
of drugs and labor in our pharmacy. This has been
brought to a most successful issue and is producing genu-
ine results now. Natui-ally, as we are an open hospital
with a large number of doctors attending, there was a
vast and varied number of drugs prescribed. To accom-
plish any change here it was necessary to have the coop-
eration of the medical men. A committee was, therefore,
appointed from the medical staff to consult with the super-
intendent and pharmacist and to investigate the whole
question and formulate a policy to produce the object
mentioned. This committee did most commendable work.
It was found that at present there is an ever-increasing
difficulty in procuring certain drugs and a great advance
in the prices of all drugs. Again, it was found that the
work in the pharmacy of the hospital had of late tremend-
ously increased and that trained pharmacists were prac-
tically impossib'.e to obtain. The committee decided that
greater economy should be practiced in the use of drugs
and in the labor of handling them. To accomplish this
the following scheme was worked out:
The pharmacist prepares a fortnightly drug bulletin,
which contains a list of drugs most commonly used, with
the present price, percentage increase over pre-war quo-
tations, the amount available, and suggested substitutes
which are more readily obtainable. This list is placed in
a conspicuous place in the hospital and a copy mailed
to each doctor's office. It was felt that the knowledge thus
disseminated would be valuable to the physicians in con-
serving, in private as well as hospital practice, those
drugs the quantities of which are low and the prices high.
It was also recommended that, if prescriptions are to
be repeated, a written order should be required from the
doctor, who would be notified the day before the medicine
was finished. In addition, the pre.scribing of drugs by
the dosage, with an indication of how many doses are to
be sent to the ward at a time, has also been very advan-
tageous. Not only does it conserve the amount of drugs
used, but it is instructive to nurses and others inasmuch
as they get more familiar with dosages. Thus when a
patient was being discharged from the hospital within a
day or so after the completion of the medicine or mixture,
only sufficient would be ordered for the duration of his or
her stay as a patient in the hospital.
It was found that certain prescriptions could be cut
down in the number of ingredients used, inasmuch as, in
some cases, an individual drug would answer the purpose
as well as two or three possibly prescribed.
Again, the various forms of administering drugs re-
quires greater or less time in preparation. For example,
emulsions take longer than capsules or powders and the
latter longer than mixtures, and thus the simpler form
of administration, employed wherever possible, would con-
serve a good deal on the labor.
Some time ago the hospital issued a very complete phar-
macopeia, and this is kept in each ward in a conspicuous
place. Every prescription or order blank which the doctor
uses in the ward has printed in the center of it "use hos-
pital pharmacopeia," and thus acts as a constant reminder.
The use of the pharmacopeia means that more stock solu-
tions can be used and more uniform methods of prescrill-
ing adopted.
It was found also that doctors, inadvertently, are not
explicit enough in prescribing, and .sometimes even call
for incompatible drugs in their prescriptions. The dis-
penser, therefore, loses time in getting in touch with such
men for revision of prescriptions. Greater care, there-
fore, in future will be employed in the writing of such
prescriptions. Again, in the prescribing of unstable solu-
tions, it must be remembered that only a sufficient quan-
tity for the period of stability should be ordered.
The excellent work done by this committee was heartily-
endorsed by the medical association and put into effect
immediately. So far the results have been satisfactory,
and in the first month the chief pharmacist reports a sav-
ing almost sufficient to take care of the payroll for that
month.
There have been many other features in our "economy
and conservation" campaign, but space does not permit
a more detailed report. From our work I have deduced
the following conclusions:
1. Every hospital should economize and conserve on
materials and everything used, as well as on labor.
2. With economy and conservation thei-e should always
be maintained an increased efficiency.
3. To economize and conserve you must have the cooper-
ation of the heads of all departments and people intei--
ested.
4. You must have organization and system to carry
such work to a successful issue, and always have careful
and constant checking.
Are your pupil nurses happy in their home? If they
are not, they will not recommend the school to their
friends, and, after all, pupils and graduates are the livest
possible advertising agents for the school. It oftentimes
happens that some little, inexpensive thing can change the
whole atmosphere of the home. The matron of the home
can tell you what the girls want — they are really girls
when they are in their home, whatever may be their re-
lation as "women" in the business life of the hospital.
The making and the executing of a good resolution are
two entirely different actions. — W. J. Locke.
68
THE MODERN HOSPITAL
THE WAR:
ITS HOSPITAL, MEDICAL
AND NURSING ASPECTS
lgp^
AMERICAN WOMEN'S HOSPITALS
Plan of Organization — Work of Doctors, Technicians, and
Lay Workers in France, Serbia, and Palestine — Ameri-
can Red Cross Gives Permission for Establish-
ment of Hospitals in the War Zone
By charlotte M. CONGER. Executive Secretary, American
Women's Hospitals, New York.
The American Women's Hospitals is about to celebrate
its first anniversary. It was organized in June, 1917, by
the War Service Committee of the Medical Women's Na-
tional Association, appointed by the association at its first
meeting after war was declared.^ The unwieldy name
"War Service Committee of the Medical Women's National
Association" was soon changed for the shorter and more
easily handled one "American Women's Hospitals," and,
through the courtesy of a public-spirited New York citi-
zen, Leo Schlesinger, was established in a suite of three
large rooms at 637 Madison Avenue, at the corner of
Fifty-ninth Street.
The American Women's Hospitals made haste slowly;
in other words, they dug deep for the foundation of their
structure and built it solidly. A broad plan of work was
formed, which included every medical need created by the
demands of the war and the call of medical men for mili-
tary service. Affiliation with the government was natur-
ally the first appeal and a committee was immediately
sent to interview the military departments of the govern-
ment and the national Red Cross in regard to the asso-
ciation of the American Women's Hospitals with these
bodies. They were told by those in authority, both in the
War Department and the Red Cross, that every medical
woman in the country would eventually be needed for war
service, but at the War and Navy Departments this com-
mittee was informed that women were not needed as yet
in the Medical Reserve Corps of these military branches
and no provision had been made for their appointment to
them, although the Surgeon-General of the Army warmly
approved the plan submitted. The Red Cross, on the
contrary, having already tried out women physicians and
found them acceptable were only too glad to avail them-
selves of the cooperation offered by the American Women's
Hospitals.
The original plan of this organization, a plan which
inspired the adoption of its name, was, following the
example of the Scottish and British medical women, to
form a chain of hospitals in the war zone. This project
did not at this moment meet with the favor of the Red
Dunning Barringer, vice-chairman
sponding secretary : Frances Cohen,
associate secretary : Sue Radcliif, tr
been increased and to the above
Drs. Mathilda K. Wallin, second
third vice-c
Walker, ch;
tary : Miss Bertha Rembaugh, counselor.
Mary Merritt Crawford, corre-
■cording secretary : Belie Thomas,
This committee has since
the following have been added :
chairman ; Caroline M. Purnell.
Chard, assistant treasurer ; Gertrude A.
committee ; Mrs. Conger, executive secre-
Cross through which all such work must be done. They
were, however, willing to send medical women as Indi-
viduals to work in the devastated countries abroad, and
sixty-two members of the American Women's Hospitals,
forty-eight doctors, and fourteen technicians and lay work-
ers are scattered throughout the devastated area of France,
on the Serbian border, and in Palestine. Dr. Lucas, in
charge of the medical department of the Red Cross in
France, now on leave of absence in this country, tells
thrilling and interesting stories of the work of these
devoted women.
At Toul, until lately, was Dr. Alice Barlow Brown of
Winetka, 111., and Dr. Marion Stevens, a dentist of Spring-
field, Mass. Dr. Brown's special work, the care of six
or seven traveling dispensaries, made such a drain upon
her that a few weeks ago she broke down and was com-
pelled to retire to rest and recuperate. Her place has
been taken by Dr. Esther E. Parker of Ithaca, N. Y. The
hospital at Toul contains two hundred beds, fifty for preg-
nant women, the remainder for children. Since it was
Fig. 1. M. Leibert. Consul General of France, Dr. Rosalie Slaughte
Morton, chairman of the executive board of the American Women"
Hospital's, and a group of doctors ready to sail for the other side
In the foreground are two Red Cr(
started, less than a year ago, between five and six thou-
sand mothers and children have been cared for by the
doctors in charge.
At Evian there is a hospital for the repatriates. Thir-
teen to fifteen thousand a day are returning from the
invaded regions. 15 percent of whom are children. In
charge of the contagious hospital at this point are two
little Quaker doctors, sisters, who were in the first group
sent out by the American Women's Hospitals — Drs. Doro-
thy and Florence Child. They write of their work there
as follows:
"We arrived safely in Paris, and were detailed to go at
once to this hospital at Evian. We found a fine hospital
building (adapted from a hotel) and a staff including 10
nurses, a dietitian, administrator, housekeeper, etc. At
that time the hospital was ten days old and had 20
patients. It is now four months old and has 180 patients,
20 nurses and 20 aids. The children we treat are refugees.
They have been prisoners of war in occupied Prance and
in Belgium for three years or more. They have experi-
enced all the horrors of war; they have lived in the din
of cannon and shells in cellars and huts. They have lots
of skin diseases from the dirt, and they are poorly nour-
ished, and nervous and fidgety because of the noise and
strain.
"The hospital has gradually developed into an isolation
THE MODERN HOSPITAL
69
system for the contagious. Every children's disease is
represented. During the winter, we had many pneu-
monias, too. We have often had as many as three bad
laryngeal diphtherias at the same time. In addition to the
hospital, we have a dispensary fitted up in the garage for
medical, surgical, and dental work. Another building is
a temporary orphanage. Here orphans spend two weeks
to see if anything contagious will develop, and to be vac-
cinated and antitoxined, before being distributed to orphan-
ages in the interior of France. In another building a day
school is run for the refugee children that stay in Evian
for a few days for any reason. Since they arrive at the
rate of 1800 to 2000 persons a day, you can understand
that they must be cleared out very promptly, to make
room for more."
Another member of the American Women's Hospitals,
Dr. Virginia Murray of California, is in charge of the
convalescent home at Lyons, a hospital containing two
hundred beds which receives the children sent on from
Evian.
In the chateau region of the Blois is Dr. Bertha Stuart,
of Portland, Ore., who is developing a hospital, convales-
cent home, and dispensary; of her work too much can
Fig. 2. A motor
hardly be said. No camionette being at her disposal, she
for a while walked ten miles hither and thither carrying
aid to those who could not come to her.
Dr. Ida Shields is at St. Etienne, the Pittsburgh of
France, where the demands are such that the doctors in
charge are working sixteen hours a day. Just now they
are establishing a hospital there of seventy beds, and
layettes have been in great demand. Dr. Shields writes,
"I don't expect you can find a place in France where there
is greater need than there is in St. Etienne. There are
150,000 refugees here living under the worst city con-
ditions."
The hospital for Serbian refugees at Vodena, Greece,
which is a converted school house, rudely equipped and
with crude but effective plumbing, is presided over by
Dr. Regina Flood Keyes of Buffalo, N. Y., with Dr. Mabel
Flood as her assistant. Dr. Keyes and Dr. Flood visit
three thousand refugee families daily, take care of sixty
to seventy dispensary patients and look after fifty bed
patients. With them it is in truth "all work and no play"
and they are handicapped in their work by lack of rank,
which both the Scottish and British women working near
them have.
Dr. Keyes writes from Vodena, Salonica, "This hospital
building was formerly a Turkish school, and we are hav-
ing it all painted inside and whitewashed outside and all
done over. We are building new sanitary toilets and put-
ting in a shower bath, not as we have in America, but
crude, still they help out."
In Serbia the American Women's Hospitals will estab-
lish a hospital of 250 beds. Through the generosity of
Mrs. Frederick Thompson, a motor laboratory has been
built and equipped which will shortly be sent to Colonel
Petkovitch in Serbia.
After a year's study of the situation on the other side,
the American Red Cross no longer holds out against the
establishment of hospitals. They have already given per-
mission to the American Women's Hospitals for the plac-
ing of two small hospitals in the department of the Aisne.
One of these is about to start and will be equipped, staffed,
and financed by the American Women's Hospitals. Its
director is Dr. Barbara Hunt of Bangor, Maine. Dr. Hunt
will have associated with her, a lay woman, Mrs. Lida
Touzalin of New York and Colorado Springs; her assist-
ant vrill be Dr. Ethel B. Fraser of Denver. Another mem-
ber of Dr. Hunt's staff is Dr. Mary Getty of Philadelphia,
who goes as opthalmologist and for general medicine.
Dr. Doherty of Milwaukee is the dentist of the group
just starting. There will be three graduate nurses con-
nected with this hospital: Miss Merrick of New York and
Miss Whitaker and Miss Pettengill of Pennsylvania. Miss
Ada Tobbitt as recorder and Mrs. Lida Braschi and Mrs.
Lehman Lenoir, ambulance drivers and mechanics, com-
plete the group.
Despite the demands of the war and the number of
physicians sent to the front, the Medical Reserve Corps
of the United States Army still remains closed to women
physicians, our country refusing to follow the example set
by the English, who have placed women in charge of their
military hospitals, notably the one in Endell Street, Lon-
don, of six hundred beds, which is directed by Dr. Garrett
Anderson. But women have been appointed as contract
70
THE MODERN HOSPITAL
Fig. 1.
the
has
surgeons in the army where they are on the same basis
as men; also — and this is a new departure — five women
bacteriologists, members of the American Women's Hos-
pitals who took the special course arranged by this organ-
ization, have been appointed as students in the Army
Medical School in Washingrton, which are important steps
toward federal recognition.
The American Women's Hospitals receive frequent re-
quests from industrial centers for women physicians to
examine and care for the factory worker and to
fill the vacancies made by the enlistment of medi-
cal men in the federal service. Also the hospitals
throughout the country are opening their doors
to women and appointing them to positions hith-
erto filled by men. This is true of nearly all the
hospitals in New York. The American Women's
Hospitals have cooperated with the Women's
Committee of the Medical Board of the National
Council of Defense wherever their work touched
and to them and all those seeking information,
their card index and cross files are open. They
are affiliated with the American Committee for
Devasted France, the Fund for French Wounded,
the National Surgical Dressing Committee, and
various other patriotic societies.
The index and cross files have been an impor-
tant feature of their work. As soon as the or-
ganization was complete an outline of the plans of the
American Women's Hospitals and registration blanks
were mailed to five thousand medical women in the United
States with the result that some fifteen thousand
registered w'ith the American Women's Hospitals
for foreign or home service. From these files
the doctors sent abroad for the Red Cross and
those furnished for the industrial plants and hos-
pitals throughout the country have been se-
lected.
The registration completed, committees were
formed with medical women of national reputa-
tion at their head for foreign service, for the
establishment of army hospitals in the home zone,
for the care of prisoners of war and interned
alien enemeis, for sanitary inspection of camps,
for laboratory work in connection with civil and
military hospitals, for hospital substitution, for
substitution in private practice, for dental serv-
ice, and for supplying physicians for industrial plants.
These committees have all been active since their creation,
save that of the care of prisoners of war and interned
alien enemies for which service no one has so far been
called.
NEW FIELD AND HOSPITAL USE FOR THE ARMY
LITTER*
Universal Instrument for Loading, Transporting, and
Treating Wounded Soldiers
The present war has developed many novel and ingenious
contrivances for the care of the sick and wounded soldiers
and new methods of using equipment already at hand.
Maj. H. B. Allen, M. R. C, director of the Camp Greenleaf
School of Applied Surgical Mechanics, has devised a simple
but effective method of loading, immobilizing, and trans-
porting wounded soldiers. His plan does not call for new
or elaborate apparatus, but utilizes the regulation hand
litter now in use by the medical department of our army.
The ideal "stretcher" is necessarily the one which facili-
le are presented by courtesy of the
tates the loading and transportation of wounded soldiers
without additional trauma, with the minimum amount of
labor, and with the greatest rapidity. Major Allen's
method of using the standard litter as a splint meets all
these requirements, and, in addition, actually places the
patient under treatment the moment he is loaded and
immobilized on the litter. The following description and
the accompanying illustrations clearly demonstrate the
value of the Allen method:
I*atient and litter turned on the left side. The foot of the injured side,
left, has been tied with the left front litter sling and the right rear sling
been passed in front of the right shoulder, down back of the pelvis and
vard through the crotch tilting the pelvis by traction on rear sling.
"Among the numerous innovations at Camp Greenleaf
there is one that viall contribute both comfort and surgical
aid to each of the million and more wounded soldiers every
year, whose wounds are so serious that they must be
transported upon a litter. This innovation costs nothing,
since it neither adds to nor subtracts from the army litter
as it stands today and has stood for many years. Loading
the stretcher requires but one man. It is literally a one-
man job, and he can crawl out on his belly to his patient
and load him on the litter, exposing himself to the mini-
mum of fire. It is obviously true that, ordinarily, two men
are necessary to carry the loaded litter. It may be trans-
ported back at any opportune time, but it must be remem-
bered that the patient is comfortably immobilized and is
actually under treatment although left alone out on the
lield. The soldier is loaded on the stretcher by first tying
the foot on the injured side to the front end of the litter
with the litter sling. The sling from the rear end of the
litter is passed over the shoulder down behind the soldier's
back and is brought up between his thighs. Then the sol-
dier's belt is used to elongate the rear sling by passing it
through the handle loop and buckling it around the rear
handle of the litter. It is buckled just tight enough to make
the pelvis tilt up on the sling side, as far as its anatomical
range will permit. The patient and the litter together are
THE MODERN HOSPITAL
71
Fit-. 3. The rear
loop of sling
side efficiently
to either side.
sling, elong:
and buckled
immobilizing:
ted by the
around the
the patient
latient'.s waist belt, is passed through
■ear handle of the litter on uninjured
and permitting the tilting of the litter
prodding:. By this means the chief element in the
production of pain is instantly eliminated. In
this connection there is another feature that is
even more important than the elimination of pain
and that is the elimination of the possibility of
additional damage due to the prodding ends of
the bones grinding against each other, or lacer-
ating the soft tissues. Lacerated tissues (hard
or soft) are known to be excellent incubators for
serious infections.
"That these fixation forces produce effective
immobilization may be inferred from the accom-
panying illustrations, and proved by asking a
patient so treated. But if one really wants to
know what a strait jacket actually feels like,
then have some one immobilize him on a lifter by
gently turned until the loaded litter rests on its
feet right side up, and the patient upon it, com-
fortably immobilized, is actually under treatment,
so far as injuries to the legs or thighs are con-
cerned.
"Immobilization by the use o£ fixation forces
for fixation purposes is the platform upon which
all successful fracture work rests. It should be
noted that the patient is loaded without being
unduly handled or carried to the litter, and no
splints are required, no grass, or weeds, or sticks
are used, nor is one crooked leg tied to another
crooked leg as a substitute for a splint. There
are many splinted patients in hospitals today
who would do infinitely better if treated on an
stretcher beare
his back. Patii
Fig. 4.* Litter approaching vertical, feet of patii
army stretcher, made up like a bed, with an
8-inch hole cut through the canvas for daily bed-
pan service. This 8-inch hole for bed-pan service
eliminates the excruciating pain endured by the
patient every time he is lifted on the bed pan.
By this method the patient and the litter are one
and his injuries are not disturbed in any way
by lifting on the litter to put the bed pan in place
and remove it.
Fractures or shell wounds of the arm, fore-
arms, legs, thighs, trunk, neck, or head are im-
mobilized and transported by the employment of
suitable fixation forces for fixation purposes.
Pads under the point of attachment and possible
pressure are readily applied as indicated.
"Pain from fractures is chiefly due to the prodding of
soft, sensitive tissues by sharp jagged bone fragments;
but if the bones are pulled down to their normal positions
ond fixed there by fixation forces, then there can be no
the Allen method. I have tried it myself and
have observed two very interesting results. First,
immobilization is certainly present in very large
quantities, and second, the complete absence from
pain or discomfort is surprising. The reason
for the absence of pain is the absence of trac-
tion. Traction is not constant; it is only present
when the litter is markedly tilted or when the
'nuscles contract, but since the muscle contrac-
tions are blocked by adequated fixation forces,
they are deprived of their normal attribute of
producing motion. The explanation is simple
enough when you stop to think about it.
"The patient can be carried with either end of
t;he litter raised, making it possible to remove
Fig. 6. Complete immobilization, all extremities broken.
wounded soldiers out of deep dugouts, or transport them
around the sharp, narrow angles of the trenches,
port them around the sharp, narrow angles of the trenches.
"All of this can be done without altering the army litter,
72
THE MODERN HOSPITAL
"As an apparatus for hospital treatment it is
only fair to say that its hospital record is in no
sense inferior to its qualities as a means of trans-
portation. The limited allotment of space pre-
vents narrating the great variety of cases more
appropriate to litter treatment than to any other
by the handles
but if a soldier has both arms and legs fractured, or is
badly torn by shell fragments, or crazed by poison gases
or other causes, then additional dressings and retention
straps would be required. With little expense these padded
straps and sole cleats, and the 8-inch hole in the canvas,
can be supplied making the U. S. litter a universal instru-
ment for loading, transporting and treating wounded
soldiers.
Fig. 8. Two men immobilized on the
Different types of Allen's shoe cleats.
single device. The many appliances now in use can be
employed better with the stretcher than without it but
that opens up another chapter much more elaborate than
that already presented."
"It has been suggested that nurses in military service
shall be given commissions entitling them to rank similar
to that accorded to medical officers. — News Item.
"Oh, Captain Nurse," the surgeon said, —
A first lieutenant pale and wan, —
He stood there on the battle field
As black of night was paled at dawn,
"Oh, Captain Nurse," the surgeon said,
"How goes the work along this route?"
"My dear Lieutenant," nurse replied,
"I first must ask you to salute."
He raised his hand to helmet brim
And she saluted back at him.
And then replied good Captain Nurse,
"I think that I've seen matters worse;
But, dear Lieutenant, don't forget
Your military etiquette."
— Illinois Health News.
Your manners will depend very much on the quality of
what you frequently think on, for the soul is as it were
tinged with the color and complexion of thought. — Medi-
tations of Marcus Aurelius.
THE MODERN HOSPITAL
73
DISPENSARY
AND
OUT-PATIENT
WORK
Conducted by MICHAEL M. DAVIS. Jr.,
Director of the Boston Dispensary.
Please address items of news and inquiries regarding Dispensary and
Out-Patient Work to the editor of this department, 25 Bennett street.
Boston, Mass.
MASSACHUSETTS FINDS EFFECTIVE REMEDY FOR
DISREPUTABLE DISPENSARIES
New Law Regulating Massachusetts Dispensaries — Dispen-
saries to be Licensed by State Board of Health
The war and its demands for physical fitness have drawn
public attention, as never before, to the menace of disease
and the agencies for preventing and curing it. In Boston,
this focusing of public attention brought to light several
disreputable dispensaries, organized purely for gain and
exploiting their patients and the community. This led
to a campaign by the Boston Chamber of Commerce,
through its bureau of investigation, of which Mr. E. B.
Hayes is executive secretary, which resulted in having
the charter of one dispensary annulled and the doors of
another closed.
At this juncture Mr. Michael M. Davis, Jr., director of
the Boston Dispensary, addressed a letter to the Boston
Chamber of Commerce, in which he pointed out that the
one effective remedy for the situation lay in statutory
state regulation. This led to a conference of representa-
tives from the State Department of Health, the State
Board of Charities, and the Boston Chamber of Commerce,
to consider the draft of an act drawn up by Mr. Davis,
providing for the licensing, inspecting, and regulating of
all dispensaries throughout the state of Massachusetts.
The bill became a law on April 2, 1918.
The law defines a dispensary as "any place or establish-
ment, not conducted for profit, where medical or surgical
advice and treatment, medicine, and medical apparatus, is
furnished to persons non-resident therein; or any place or
establishment, whether conducted for charitable purposes
or for profit, advertised, conducted or maintained under
the name 'dispensary,' or 'clinic,' or other designation of
like import." The law makes it unlawful for any person
or association other than the regularly constituted authori-
ties of the United States or of the Commonwealth, to
establish or conduct any dispensary within the Common-
wealth without first obtaining a license.
Any person or association desiring to conduct a dis-
pensary must apply in wi-iting for a license to the State
Department of Health. Attached to the application must
be a statement containing such information as may be
required by the department of health. If, in the judgment
of the department, the statement filed and other evidence
submitted in relation to the application indicates that the
operations of the proposed dispensary will be for the
public benefit, the license is issued to the applicant.
Licenses expire at the end of the calendar year in which
they are issued, but may be renewed annually on applica-
tion. No license is transferable except with the approval
of the department of health. For the issue or renewal
of each license a fee of $5 is to be charged, except for
incorporated charitable organizations which conduct dis-
pensaries without charge, and which report, as required
by law, to the State Board of Charities.
The law provides that the public health council of the
Department of Health shall make rules and regulations
in accordance with which dispensaries shall be licensed
and conducted, but no such rule or regulation shall specify
any particular school of medicine in accordance with which
the dispensary shall be conducted.
The commissioner of health and his authorized agent
have authority, under this law, to visit and inspect any
dispensary at any time in order to ascertain whether it is
licensed and conducted in compliance with the law and
with the rules and regulations under which it is estab'
lished. The State Department of Health may, if in its
judgment the public interest so demands, revoke the
license of any dispensary after thirty days' notice and
opportunity to be heard.
Dispensaries legally incorporated or in operation in the
state, at the time of the passage of the act, are allowed
upon application to continue in operation for the remainder
of the calendar year, without fee. The State Department
of Health, however, is directed to have an inspection made
of all dispensaries in the state by December 31, 1918. .\ny
person or association conducting a dispensary without
license, or wilfully violating any rule or regulation made
under the authority of this act, is guilty of a misdemeanor,
and if convicted must pay a fine of not less than SIO or
more than $100. A separate and distinct offense is deemed
to have been committed on every day during which the
violation of any provision of this act continues, after
due notice of the violation is given in writing by the
department of health to the authorities of the dispensary
concerned. The commissioner of health is made responsible
for reporting any violation of the act to the attorney
general.
New York and Boston Call for Volunteers for Dispensary
Service
With the progress of the war and the growing with-
drawal of physicians from civil life into military service,
the dispensaries throughout New York City, like dispens-
aries elsewhere, are finding it increasingly harder to man
their clinics adequately. In some instances, where all the
physicians of given clinics have entered the army service,
the dispensaries have actually been forced to close them
for the period of the war; in other instances the services
have been curtailed, often seriously; and in not a few-
instances the men who remain are carrying an almost
unbearable burden of work and responsibility. In an
effort to relieve this situation somewhat and to enable the
dispensaries to meet the increasing demands that are
bound to be made upon them as the war goes on, and the
lack of physicians makes dispensary treatment imperative,
the Associated Out-patient Clinics of New York have
called upon the New York, King's and Bronx County Medi-
cal Societies to bring this situation to the attention of
physicians at large and to urge as many as possible to
volunteer their services for the duration of the war. It
is to be hoped that many who have had dispensary ex-
perifiice, but who at present have no hospital or dis-
pensary affiliation and who, because of age or for other
reasons, are not available for medical service, will volun-
teer for dispensary duties as their contribution to the war.
74
THE MODERN HOSPITAL
INDUSTRIAL
REHABILITATION
OF DISABLED
SOLDIERS AND SAILORS
Conducted by ELIZABETH G. UPHAM.
Director Art Department Milwaukee-Downer College.
AGRICULTURE FOR THE DISABLED*
Experience of Various European Countries and Canada —
Tlierapeutic Value of Agriculture
In every country, the men left the plow, the orchard,
and the dairy to join the colors. Every country is meet-
ing the necessity of returning her men to the land, many
of them severely handicapped. To what extent agricul-
tural pursuits are suitable to the! disabilities of war
invalids, has been a matter of serious concern.
Agriculture at first glance seems especially unsuited to
the disabled. Adequate remuneration for the hard work
Fig. 1. Poultry
ling for blinded soldi*
expended is difficult, at best, for the average farmer.
Agriculture, however, is becoming more and more special-
ized, and scientific instruction is not only decreasing labor
but increasing yields. Moreover, the motor tractor and
modern machinery are performing an ever-increasing part
of the heavy farm labor. Farmers' institutes, rural organ-
izations, good roads, and automobiles are overcoming the
isolation of the farmer. Moreover, serious study made of
agricultural occupations in relation to disabilities, shows
*The illustrations accompanying this article have been supplied by
courtesy of the Red Cross Institute for Crippled and Disabled Men,
New York City.
that these occupations are of therapeutic value in many
conditions. Patients with arrested cases of tuberculosis,
neurasthenia, shell-shock, and gassing improve perceptibly
by employment in the open. Prosthetic appliances have
a variety of grasps and devices designed to enable the
men who have suffered amputations to perform farm work.
In the shortage of farm labor, therefore, it has become
the economic policy of every nation to return to the land
those who are capable of production.
Fig.
vith right arm amputated who has been fitted with
:e which permits him to use the scythe, etc.
France made the early blunder of permitting 90 percent
of her disabled from rural districts to train for clerical
positions. The tendency had been for the agricultural
workers of France to go to the front and for those engaged
in industries in cities to remain as munition workers.
Therefore, industrial occupations, especially the apparently
easy clerical positions, looked attractive to the returned
soldier and seemed to offer less liability for him and his
sons to take part in future wars. France had to institute
an active propaganda for the return of her men to the land
in order to offset this early blunder. The men are fre-
quently loath to undertake agriculture with its isolation
and heavy work. As one Canadian soldier expressed it,
"I have had all the land I ever want, slept on it, ate it,
and had it on my clothes." Another soldier said that he
didn't want any more fresh air, he preferred a warm
shelter and the close atmosphere of the movies.
The nations have found it necessary to make special
inducements in their propaganda to return the men to
the land. Germany has a scheme whereby she grants
small rural homesteads to war invalids and further assists
them by loans. In Italy the men's pensions are accepted
as security by all public administrative bodies for loans
for buying lands.
THE MODERN HOSPITAL
To
In France it is proposed to have an occupational map
on which will be represented all the products of French
soil. With this map will go a stirring appeal to the agri-
culturalists to show them the trades and occupations which
handicapped men can undertake upon the land. France i.s
primarily an agricultural country, and the terrible wastage
of her fields, the destruction of her orchards, vineyards,
roads, and rural communities can only be restored by train-
ing her returned men in new methods of intensive farming.
Great Britain is making extensive plans for colonization.
Canada is studying crown-land legislation which is in
advance of even Australian schemes. The land settlement
Fig. 3. Soldier with double forearm amputation working with a spade.
Right arm with single hook, left arm with ring hook "Aubut."
plan of Ontario is particularly interesting. The Soldier
Settlement Act provides that Dominion lands on each side
of a railway shall be reserved for a depth of fifteen miles
for returned soldiers. The government proposes to give
each settler an eighty-acre lot, including a ten-acre clear-
ing, and a loan not to exceed $500 for the purchase of tools
and live stock. Roads will be built, a community life
provided, and the men given agricultural training and
supervision. In each center there will be houses, heavy
farm implements, and machinery which will enable the
men to have the use of the best agricultural equipment on
easy terms.
The men are placed in communities where they may have
some social life and where they will be supervised. They
are carefully directed into that branch of agriculture
which will not only be beneficial for them, but at which
they may hope to secure a fair living. They are, more-
over, given the opportunity of special instruction in an
agricultural school for the disabled. The men apply them-
selves with concentration and enthusiasm. There are
classes in truck gardening, bee and poultry-raising, stock-
breeding, dairying, farm mechanics, soil analysis, fertiliz-
ation, and farm economics and management. The first
prize at the Edmonton Horticultural Society Show was
won by a member of the Canadian Vocational Training
Class, for vegetables grown in competition with profes-
sional growers of Alberta.
The providing of agricultural instruction and the propa-
ganda to return the men to the land has thus far been
conceived chiefly as a national economic policy by the
government in order to increase farm production, develop
new resources, and removed the disabled from congested
cities. The return to the land, however, has a special
significance to doctors and to those engaged in rehabilita-
tion, for the land and agricultural processes offer real
therapeutic possibilities when properly understood.
While the patients are convalescing their agricultural
training is begun. The exercise, out-of-door life, and
healthy interest benefit the patient as well as hasten his
recovery. Several French surgeons testify to the superior-
ity of exercise on the land over the induced exercise of
mechanotherapeutics. Dr. Bergonie compares the results
in after-care of the wounded at Temporary Hospital No. 4,
Grand Lebrun, Bordeaux, which is a physiotherapy center,
with the work at Martillac where the men follow pre-
scribed exercises in the fields. He says: "We were able
to prove how far the agricultural remedy was superior
in percentage of cures as well as in rapidity and thorough-
ness to mechanotherapy, and even to all physiotherapy,
cariicd on indoors at the Grand Lebrun Hospital."
Accidents and changes for the worse do not exist: 80
percent of the men, after agricultural treatment, are cured
and able to return to the service, only 10 percent showing
76
THE MODERN HOSPITAL
an improvement insufficient to permit them to return, and
3 to 5 percent remaining in an unchanged condition.
Collective work under supervision yields better results
than individual work.
There is one danger in the work. The enthusiasm which
the men feel when they find themselves once more in their
fields, and when they find that they are again capable of
productive labor is so great that they may overdo and
retard their recovery. For this reason, it is necessary
not only to assign each man the task compatible with his
disability but to limit his effort.
Thus work is made progressive and is interrupted by
frequent periods of rest. The open air and sunshine are
not without their benefit also. Faces that are pale in
the hospital rooms of mechanotherapeutics, regain their
color and tan in the open.
There must be the most careful selection of cripples.
The nature of the work and the functional condition of
the cripple must serve as guides. For instance, occupa-
tion could not improve such conditions as ankylosis, a
limitation of motion due to an osseous obstacle, or paretic
disorder caused by injury to the nerve, whereas an articu-
lar stiffness, caused by contraction or prolonged immobility
or functional disuse, is benefited by occupation.
The success of agriculture as a therapeutic agent lies,
first, in the careful choice of patients, second, in adapting
the occupation to the functional disorder, and, third, in
the constant supervision of the patient in order to see
that he is deriving benefit rather than harm from his work
and that he is well housed and fed and his resistance to
fatigue increased. The work thus supervised constitutes
a real cure.
The regents of the University of Michigan at Ann Ar-
bor have had plans drawn for the erection of a $35,000
building for children at the University Homeopathic Hos-
pital. The new building will be a two-story structure
with basement and attic, and will be located thirty feet
east of the main unit of the hospital, with which it will
be connected by an underground passage. The exterior,
like that of the main building, will be of pressed brick
with a tile roof. Although, owing to the present high
cost of materials, the structure will not be entirely fin-
ished by next summer, the first and second floors will be
ready for patients at that time. Each floor will contain a
public ward with 50 beds each and three private wards, be-
sides executive offices, examining rooms, and treatment
rooms. When the remainder of the building is eventually
completed, the basement will quarter the x-ray department,
and the attic will serve as a storeroom.
The Lake County Council for Defense at Crown Point,
Ind., have drawn up a resolution to be presented for
adoption by the Board of County Commissioners provid-
ing for the establishment of a county tuberculosis hospital,
at an initial expense of approximately $100,000. It is ex-
pected that the commissioners will authorize a bond issue
to be presented to the bond attorneys in Indianapolis for
their approval, and in the event that they decide that
there is any doubt as to the legality of the action taken by
the county commissioners without submitting the proposi-
tion to a vote of the people of Lake County, a friendly suit
will take place in order to settle the point. The action
taken by the County Council for Defense was instigated by
the refusal of their chairman to accept the opinion of At-
torney General Stanbury and Judge O. L. Wildermuth of
Gary, that the commissioners can establish the hospital
without submitting the question to the voters.
AN AMERICAN SCHOOL OF REEDUCATION FOR
CRIPPLED MEN
The Work of the Red Cross Institute for Crippled and Dis-
abled Men of New York City— The Methods of
a Special Employment Bureau for the
Handicapped
By DOUGLAS C. McMURTRIE, New York, Director of the Red Cross
Institute for Crippled and Disabled Men, President of the Federa-
tion of Associations for Cripples, Editor of the American
Journal of Care for Cripples.
[Continued from Ju
DEPARTMENT OF FIELD WORK
An important feature in the work of a reeducational
school is getting in touch with prospective pupils at the
earliest possible date. Actual case work in the field not
only eflfects acquaintance with suitable subjects for train-
ing, but also, by bringing to light the economic experi-
ences of cripples who have succeeded in overcoming their
handicaps, is extremely suggestive regarding possible
trades, employment opportunities, and the methods to be
followed in dealing with other cripples similarly disabled.
The first field activity of the institute consisted in a
study of case histories of disabled men whose injuries had
occurred since January 1, 1915. Trace of such cases was
obtained through the hospitals of the city, through the In-
dustrial Commission, through a public service corporation,
and through other sources. The cases thus listed num-
bered in total 743. From those men who could be found,
361 complete case records were obtained.
The findings of the study, as prepared by Dr. J. C.
Faries, have been published in detail, and will be found
of much scientific interest. Another consequence of the
study was that it put the institute in communication with
many men who could profit by instruction in its training
classes.
The principal field activity at present is persistent vis-
iting of the city hospitals by a social worker experienced
in dealing with cripples. This worker gets in touch with
maimed men immediately after the amputation has been
performed, gains their friendship and confidence, stimu-
lates their courage, and plans with them their future pro-
gram of training or employment. Under these circum-
stances, a disabled man can leave the hospital with a very
definite prospect in view.
Another activity of this department is the conduct of
a series of "parties" for cripples, the object of which is
to hearten and encourage the handicapped men who are
losing out by bringing them in touch with the cripples who
have overcome their obstacles. The first gathering of this
sort was nothing short of inspiring. Over two hundred
cripples were invited, and over seventy-five came, al-
though the evening was one of the coldest of the winter.
The director of the institute opened the meeting with a
description, in simple language, of what was being ac-
complished by war cripples abroad, and illustrated with
a generous number of lantern slides and one moving pic-
ture. Next were shown two motion pictures showing two
successful cripples at work and play. In conclusion, two
cripples themselves told the audience of their experiences
in getting the best of their handicaps. One of them had
amputations of both arms, yet runs one of the busiest
news stands in New York; the second lacked one arm
and one leg, but has risen to be purchasing agent of a
large western corporation. Then came ice cream and
cake. Most of the men lingered long to swap experiences.
The influence of the meeting was reflected immediately
in an increase of applications to the employment bureau
for work and to the educational department for admis-
THE MODERN HOSPITAL
77
sion to the industrial classes. The experiment was a vivid
demonstration that no one can encourage a cripple so effec-
tively as another cripple.
The second meeting was similar in general plan, and if
possible, even more inspiring. It was addressed by two
men, one of whom has lost both arms, the other lacking
one arm and both legs. There were shown for the first
time three moving pictures, planned and photographed by
Capt. Arthur Samuels of the surgeon general's office. Each
illustrated how the seriously handicapped ciipples over-
come their obstacles.
Between pictures there were short talks to the crippled
audience by crippled speakers. The first address was by
a man whose extremities had been frozen by exposure in
a blizzard, and consequent amputation of two legs, one
arm and four fingers of the remaining hand. He had
then become for two years an inmate of the poorhouse.
He told the county authorities that if they would give him
just one year in college, he would never again cost them a
cent, persuaded them to do so, and made good his predic-
Institute for Crippled and Disabled Men
tion. He later rose to be speaker of the house of repre-
sentatives in his home state, and is now president of a
flourishing bank in the middle west. "If your mind and
spirit are straight," he says, "no other handicap can keep
you down."
The next speaker had had one leg amputated and
started under this handicap with no educational or finan-
cial advantages whatever. The best job he could get was
as a shipping clerk, but he soon found there was no fu-
ture for a disabled man in a manual and unskilled job.
Under great difficulty, he attended night school, and finally
obtained modest employment under civil service auspices.
He now occupies a position requiring a high degree of ex-
pertness and experience.
The last speaker lost both arms in an accident; one is
amputated at the shoulder, the other just below the elbow.
He found almost hopeless difficulty in getting the first job,
becoming meanwhile almost a vagrant. At last he ob-
tained employment supervising a gang of unskilled labor-
ers. From that point he has risen steadily. He has in-
vented and manufactured his own appliances, with the
aid of which he does practically every duty of daily rou-
tine, including putting on his collar and tie, engaging in
a game of bowling, or pruning his own peach trees. He
was elected by his county to be justice of the peace, and
later was thrice chosen for the responsible task of county
judge, which office he now holds.
The "cripple parties" are an assured success and will
be continued as a permanent institution.
EMPLOYMENT DEPARTMENT
Historically, the placement of crippled and disabled
men has been found one of the most difficult specialties in
social work. It has been attempted at various times and
places, but in few instances have the efforts been suc-
cessful.
One of the successful efforts was a small employment
bureau for cripples, which was established by the Federa-
tion of Associations for Cripples in cooperation with Hud-
son Guild. At the time the institute was established, this
bureau had been in operation a little
over a year. As its work, however,
led directly along the line of the re-
educational program, and as the
bureau was handicapped by lack of
facilities, it was taken over by the
institute. This early experience
proved a splendid foundation on which
to base the more extensive activities
now under operation.
The employment department is not
a general bureau for the handicapped,
but registers orthopedic cases only.
Experience of the first three months
has clearly shown that there are a
great many crippled men out of work
who are anxious for advice and em-
ployment. Two hundred and twenty
cripples, applying for work, have been
registered during this three-month
period. These men have been referred
to 355 positions and 123 placements
have been definitely made. The aim
is to secure positions which will be
permanent and constructive, rather
than merely to place many men.
Applicants for work are referred to
the bureau in many ways. A great many of them hear
of the work through newspaper publicity, others are sent
by the Workmen's Compensation authorities, by other
employment bureaus, by charitable societies, the hospitals,
the municipal lodging house, and still others come through
cripples who have themselves been placed. Each week
the number coming into the office increases.
Every applicant for work is registered carefully and
an effort is made to find out just what kind of employ-
ment he wants. It is pointed out to him what lines of
work will be injurious in consequence of his type of handi-
cap. The hospital he is attending is consulted for a rec-
ord of his disabilities, and, where possible, the physician
in charge of the case is asked to advise what work is suit-
able. The man is questioned as to his work history in or-
der to discover whether he has any experience of which
ad-antage might be taken in planning his future occupa-
tional career. The endeavor is always to place the man
where the work will be most congenial to him and where
he can make the greatest use of his past experience.
78
THE MODERN HOSPITAL
After there has been made analysis of the work suited
to the applicant, the task is to get him a job. One method
of securing employment is through letters in the newspa-
pers and other forms of publicity. Many employers are
now prejudiced against cripples, and it is a difficult task
to create a real demand for them. It is felt, however, that,
if there can be discovered, through a careful study of in-
dustrial processes, just those niches in which a cripple
can be as useful as a normal man, the department can in
time get employers to call on it when they can use crip-
ples. They will realize that the effort is not to foist upon
them unplaceable applicants, but to do a truly scientific
job of placement. It is encouraging to note that, in the
first week of its operation, the institute bureau had six
calls for workers. During a recent week, seventeen em-
ployers called on us for help and were willing to take
cripples.
A great many of our positions are secured through the
cooperation of the State Clearing House for Employment
Offices. All calls open at the non-commercial agencies
throughout the city are listed by the clearing house and
are transferred to any bureau which has a suitable appli-
cant. The department keeps a list of all employers who
have ever used its services, and, when there applies a
man who seems adapted for a particular kind of work,
we call up the appropriate employer and try to interest
him in the applicant.
After a cripple has been placed, there is made a real
effort to keep in touch with him. Occasionally, his home is
visited and, in some cases, the employer is interviewed
after the man has been employed about a month. One
evening office hour is held each week and the most ef-
fective follow-up work is done at that time. At a recent
evening office hour, thirteen men called to report how
they were getting along at their jobs. Many little read-
justments while at work can be made in this way.
SURVEY OF INDUSTRIAL PROCESSES
There is being made an industrial survey in order to
discover what are the best opportunities for cripples in
the industrial field. This serves a double purpose in that
it is productive not only of the theoretic knowledge, but
also the actual positions in which cripples can be placed.
When the field workers make their calls, they ask whether
the individual employers can use any of the applicants reg-
istered as seeking work.
For this survey, there have been listed the larger indus-
tries in Greater New York and selected for investigation
those which seem most suitable for cripples, such as the
shoe industry, leather goods manufacture, piano action
work, toy-making, and cigar factories. In each industry,
the field worker visits the manufacturers' association, the
trade union secretary, the trade journal editor, and a
number of typical factories. The facts gained in these
investigations are checked or neutralized by the experi-
ences in these trades of the crippled workers, careful rec-
ord of which is also kept. When these facts are all
brought together, it is planned to give them publicity, so
that each manufacturer will be induced to see just where
he can, without detriment to his business, make use of
cripples in his employ.
There are many discouraging features in the work of
finding employment for cripples. The employers are preju-
diced and there is often but poor material to offer them.
Eventually, however, it is hoped that the department will
be prepai-ed to deal with every type of cripple and give
him really scientific aid toward securing the best kind of
job.
[To be continued.]
A Plea for the Hourly Nursing Service as a War Measure
To the Editor of The Modern Hospital:
The idea of an hourly nursing service is not new.
Hourly nursing has proved itself successful over a period
of years in our large cities. Since its former success
augurs well for its future success on a much larger scale,
let us see if this form of nursing service to the rich and
middle classes would answer in some measure the needs
in the private homes and in the hospitals.
Many private-duty nurses have not yet responded to
the call from the surgeon-general's office. Many hospital
nurses and many public welfare nurses answered the call
to the colors during the first year of our engagement in
the war, but in almost every case to the detriment of
the institution or the organization they represented, since
both classes of workers represent assimilative and ab-
sorptive processes in the format-ion of the aims and ideas
of either class of organization.
It is true that large numbers of private-duty nurses
answered the call to the colors. It is true that they are
still answering the call, but not yet in sufficient numbers.
How does the hourly nursing service solve the problem
now confronting us?
In several ways. First, the private-duty nurse is more
easily adjusted to the national service than any other
woman in the profession, being more or less of a free lance
as to the disposal of her time, her work, and her freedom.
Is she ultimately through her present program meeting the
great economic problems of the masses? The private
nurse has met a need in the private home and she has
discharged that need splendidly, but she has also been a
luxury to the individual patient in many instances. Now
that the days of selective and individual luxury are no
longer fashionable, is it not time for the people ther.-selves
to forego a luxury, that the army may secure a necessity?
How, then, may the private patient in his home receive
adequate care? Here is the place for the ample use of
the Red Cross home nursing course. Here might be the
fulfillment of its primary object, the care of the sick in
the home. The graduate nurse, spending one or more
hours, can give important and necessary treatment in the
home and through the hourly nursing system care for a
number of patients a day. The family, taking its orders
from the doctor and the graduate nurse, cannot deviate
very far from the proper course, for in this day of tele-
phones the nurse can easily be reached or recalled. With
a suitable fee adjusted by the hourly nursing department
of the registry, a graduate nurse can earn easily as much
a day and week as by doing strictly private nursing.
Through this method, older women in private duty and
not physically fit for war service can give valuable if
not larger service to the people of both the rich and the
middle classes who are now clamoring for private nurses.
Private nursing would thus fall into two classes of serv-
ice: the care of the acutely ill and the care of milder
THE MODERN HOSPITAL
79
forms of disease. The acutely ill will need the constant
services of the nurse, but the minute that the disease
takes the milder course the private-duty nurse should be
released and hourly nursing instituted.
In the hospitals many patients would do quite as well
if they shared in the time and expense of a nurse with
other patients. One graduate should take ample care of
two patients recovering from the milder forms of surgical
procedure. It is well known how often the graduate nurse
puts in time in convalescent nursing. In normal times of
peace one would hesitate to make comment, but in war
where every nurse must weigh the matter on the altar of
conscience, duty, and patriotism, she should hesitate long
in these days before she Ijeconies willing to spend precious
hours crocheting through the convalescent period of the
mild illness of her patient.
It is safe to assume that our private families are will-
ing to make the sacrifice. Knowing that nurses are at
hand for hourly work and that the necessary and major
treatment can be given by the hourly nurse, they will no
longer hesitate to serve the meals and wait on their loved
one, if thereby more nurses and yet more nurses are re-
leased for service with our soldiers. The hourly nursing
system could be adjusted to hospital conditions also. The
great cry for private nurses with our hospital patients
has been justified in a large measure, since class work and
demonstration work has prevented uninterrupted service
from the student nurse on duty on the private floor. With
the main treatment given, however, an acutely ill patient
would receive ample and adequate care, and in the main
would be satisfied. The alternating service of one gradu-
ate nurse for two private patients seems to be perhaps
a better program for the acutely sick in hospitals, while
the hourly nursing program in many cases is also entirely
feasible.
I believe that we shall ultimately have to resort to
some method in order that the best nurses this country
has to offer shall be found with the boys at the front and
in our cantonments. Why wait? The need is now. The
loyal physician, the loyal hospital, the loyal family, can
easily make this adjustment. It should be done with care,
through a well-organized registry, and it seems to me that
by this process many women who are so dependent on pri-
vate nursing as their only outlook will get the larger
point of view and enter their country's service.
If this cannot be done as an issue to meet an issue,
then, nurses of America, let us do no less than our men
have done. Let us be willing to be sorted out and when
sorted let us not be found wanting.
The call is here and the time is NOW.
Eleanor E. Hamilton, R.N.,
Dayton, Ohio.
No pleasure is comparable to the standing upon the
vantage ground of truth. — Bacon.
"Speak thou the truth. Let others fence
And trim their words for pay;
In pleasant sunshine of pretence
Let others bask their day.
Guard thou the fact: though clouds of night
Down on thy watch-tower stoop,
Though thou shouldst see thine heart's delight
Borne from thee by their sweep."
There would be more sunstrokes in the world if it were
not that the shadows of dull men made nice cool places for
the others to walk in.
The Dietitian Problem in the Small Hospital
To the Editor of TuE Modern Hospital:
I have read and reread the interesting discussions of
the subject of hospital standardization in the Bulletin of
the American College of Surgeons, and in connection with
Dr. Hornsby's talks on dietitians I decided to ask for
opinions on my own ideas of this subject.
The well-trained dietitian is a scientific person, and as
such is very valuable, yet in a hospital of the size of mine,
forty to fifty patients, we have not felt able to afford to
ask only scientific work of the dietitian, and yet the combi-
nations so far have not been satisfactory. We have tried
the combination of dietitian-housekeeper, and I am sure
it has many disadvantages, especially in this day of in-
efficient and insufficient help.
Now I am wondering if the combination of dietitian and
laboratory technician would be practical, and if there is
a dietitian who would give it a trial? To make these sepa-
rate positions in a small hospital and afford the salary to
each to insure efficiency is almost impossible, yet it seems
to me if the dietitian were relieved of some of the present
practical unscientific work, she would be able to accomplish
the scientific work connected with each position.
A rough idea of the duties of the position would be: to
make out or supervise all menus, to meet the physicians
to discuss special diets, to supervise the preparation of
special diets, to do routine laboratory work and history-
taking, and to instruct the pupil nurses in dietetics and
bacteriology. It sounds like a medley, I will admit, yet,
considering that many times we are caring for as low as
twenty patients, it is not so bad as it looks. I would cer-
tainly appreciate hearing how some of the other hospitals
of the size of this are arranging to meet requirements
along these lines.
I felt very guilty when I read of Dr. Hornsby's disgust
when he found the dietitian attending to "getting out the
trays for the private patients," yet I know many times our
dietitians have been doing just that. I hope that Dr.
Hornsby will give his opinion on a way out for the small
hospital. Perplexed.
Your idea of the combination of dietitian and laboratory
technician is not at all an impossible one, though at pres-
ent it is not usual. Many college graduates with a good
and fairly thorough knowledge of chemistry and bacte-
riology are becoming dietitians. In cooperation with a
medical man who is able and willing to follow up accurate
laboratory methods, such a dietitian-technician could be
of great value to a hospital, especially one of the smaller
institutions. Unfortunately the other combination to which
you refer, dietitian and housekeeper, has been more com-
mon and does not appeal to our better-trained women.
Not until the hospital is willing to give proper recogni-
tion and authority to the dietitian will this work attract
the more efficient women. It is quite certain that in this
formative period in the specialty of dietetics, each small
hospital must be a law unto itself and meet the problem
with the personnel available. In some cases even an in-
telligent well-educated woman who has had no special
tr"<'ning will be able to make use of one or more of the
many available text-books and draw on her own native wit
and resources, drawing also on the help she can get from
members of the hospital medical staff.
80
THE MODERN HOSPITAL
NEW
INSTRUMENTS
AND EQUIPMENT
VINCENZ MUELLER. Technical Editor.
GEO. W. WALLERICH. Associate Editor.
Please address items of news and inquiries regarding New Instru-
ments and Appliances to the editor of this department, 327 Southeast
avenue, Oak Park, Illinois.
The Sargent Water Still
MQst authorities are agreed that, for medical purposes,
pure water is preferable to the so-called medicinal spring
waters, for the reason that all of the latter contain more or
less impurities in the form of salts or organic matter,
which is not the case with distilled water. Distilled water
is considered absolutely pure, no matter how foul the
water may have been from which it was obtained.
Sargent still for prod'
The manufacturers of the Sargent still are producing a
number of different apparatus, suitable for home use a.=:
well as for use in industrial plants, sanatoriums and hos-
pitals. In smaller institutions which are not equipped
with steam plants an automatic still is recommended. This
is connected up to running water, to a sink for the over-
flow, and to gas. The distilled water may be piped into a
5-gallon jar or half-gallon bottle, just as desired, and no
attention need be paid to the still after starting, except to
remove the full bottle of aqua jmra. Such a still has a
capacity of 2 gallons per hour at a cost of 2 cents per
gallon.
For large hospitals or industrial plants where great
quantities of drinking- water are consumed and where
steam is available, the steam-operated automatic still is
recommended, having a capacity of from 2 to 10 gallons
per hour. This still will furnish drinking water for 30 to
•50 people in the hottest weather. Where electric current
is available at from 2 to 4 cents per kilowatt and gas is
not obtainable, electric stills can be furnished.
The Sargent still is well made of heavy cold-rolled spun
copper and lined with block tin. The manufacturers are
willing to guarantee that this apparatus will furnish for
drinking or culinary purposes aerated distilled water free
from all microbes, injurious gases, or mineral salt.
The "Verithin" X-Ray Cassette
The construction of various types of cassettes vary.
The average cassette is so thick that it is an uncomfort-
able object for the patient to lie upon. The Mcintosh
"Verithin" Cassette is extremely thin, as the 8 by 10 inch
size is only 5/16 inch thick; while the 11 by 14 inch and
14 by 17 inch sizes are 7/16 inch thick.
The illustration shows the ease with which a plate may
be removed after an exposure without lifting it with the
finger-nail or scratching the film, as with other types of
cassettes. An aluminum spring flap underneath the plate
may be raised by inserting the finger in a hole underneath,
thus raising the plate. When closed the aluminum flap
Mcintosh "Verithin" cassette, illustrating ease of removal of plate.
covers the hole, making it light-proof. Many cassettes are
extremely awkward to manipulate, especially in the larger
sizes, some of them being almost impossible to close even
with both hands.
This cassette is reversible. Exposures can be made from
either side. The walls are of sheet aluminum, offering
practically no resistance to the x-ray. The intensifying
screen, when ordered with cassette, is mounted in the up-
per panel, so that when it is raised, no obstruction is pres-
ent to the removal of plate; neither is there any chance
of scratching the screen, as is the case when the screen
is placed underneath the plate. A simple, but effective
clasp closes the cassette tightly. Operators who do a great
deal of work and realize the annoyance of manipulating
an inconvenient cassette in darkness or semidarkness will
welcome this improvement as worth many times the small
cost of the device.
THE MODERN HOSPITAL
A Monthly Journal Devoted to the Buildiyig, Equipment, and
Administration oJ_ Hospitals, Sanatoriums, and Allied Institutions,
and to their Medical, Surgical, and Nursing Services
Vol. XI
Aug//st, 1918
No. 2
STANDARDIZATION OF STATE HOSPITALS*
Public Charitable and Penal Institutions a Part of the Hospital System — An Ideal of
Purpose and Object — Some Suggestions in Regard to Constructions — Hos-
pital Hards and the Chronic Patient — Follow-up Service and
Out-Patient Clinics — Elimination of Waste
By a. L. BOWEN, Superintendent of Ch.\rities, Department of Public Welfare, Springfield. III.
TN all that has been said and done in behalf of of care and treatment in which medical science
-»- better hospital standards, the state hospital,
the private sanatorium for mental and nervous
diseases, and those state eleemosynary institu-
tions in general which involve more or less of
medical and surgical treatment and research,
have been given scant consideration.
THEY ARE JUST AS IMPORTANT
In my opinion they are quite as worthy of atten-
tion as the general hospital ; I am sure they are as
important in every respect ; they represent vast
investments of capital; they require tremendous
sums for maintenance; they minister to rich and
poor at the expense of the taxpayer; they are
concerned with problems of disease and social
conditions infinitely more complex than any of
the physical diseases which receive attention in
general hospitals ; their patients are as numerous
as the patients of the general hospitals, and their
burden upon the lives and resources of our people
forms the biggest single item in the tax budget.
Moreover they are subject to sinister and distract-
ing influences, peculiar to themselves, which tend
to the demoralization of organization and paraly-
sis of effort.
ALL ARE PLACES FOR CARE AND TREATMENT
Reduced to simple terms, our state charitable,
correctional, and penal institutions are all places
•This paper is the fourth in a series, by various authoi-s, on the
standards of the various classes of special hospitals. The first. ' Stand-
ards for a Children's Hospital," by Stafford McLean, appeared in May;
the second, "The Standards of Hospital Education for Interns," by J.
M. Baldy, was published in June; and the third. "The Standardization
3f Hospital for the Insane." by William C. Sandy, was published in
the July issue.
plays the leading role. They differ from general
hospitals only in methods, application, and tech-
nic. All of them must care for acute and chronic
physical sickness among their inmates. All of
them must, or should, practice surgery. All of
them require skillful nursing and competent med-
ical ofiicers. Mental and nervous cases present
additional medical and psychological problems,
and the neurologist, psychiatrist, and alienist are
essential. The mental nurse, in addition to regu-
lar "R.N." training, must have had psychiatric
theory and practice. To these patients we should
bring the psychologist and the occupational
therapist. The research field here is unlimited.
In correctional institutions we have present, in
addition to the physical ailments, delicate and
complex mental phases, quite distinct from those
found in the hospitals for the insane and the col-
ony for feeble-minded, but none the less mental in
character.
Children's institutions offer another line of
work, involving education, which even among so
many of the so-called normal dependents, must
be given by methods different from those in vogue
in public schools.
CONSIDER THE STATE HOSPITAL ALONE
The whole system of public charitable and penal
institutions should be considered as a hospital sys-
tem ; the day is near when it will be so thought of.
But 1 want to confine this article to the state hos-
pital— tlie institution where the state is supposed
to be caring for and treating the insane.
82
THE MODERN HOSPITAL
With few exceptions these institutions do not
deserve the name "hospital;" it has been applied
to cover up deficiencies; it is also a milder and
gentler term than "asylum," its much-beloved
predecessor.
PLACES OF DETENTION W^ITHOUT IDEALS
Taken the country over, these institutions are
places of detention without standards or ideals.
In nearly all states they are a part of political
machinery. Superintendents and employees are
payroll patriots, more engrossed with the business
of keeping the party or organiaztion in office than
in doing something for their patients or studying
means for relieving the taxpayer. It is not nec-
essary to go into detail as to conditions which ex-
ist ; they are well understood.
The remedy lies in publicity; in presenting to
the public and to officials, some ideals of state hos-
pital service and offering a standard which every
state hospital must attain or be characterized as
unfit and unworthy either of confidence or of
ta.xes.
AN IDEAL OF PURPOSE AND OBJECT
Any scheme of standardization of state hospi-
tals must first of all submit an ideal, not an ideal
of physical plant or of medical staff", or of internal
management and policy, but an ideal of object
and purpose. What has the state hospital been
created to do? What are its functions in society?
Is it to be a hospital in the true sense, ofl'ering
not alone medical and surgical service, but also
reeducational advantages, occupational therapy,
employment to the patient and to the professional
man — a scientific field of the highest type, whose
objectives are not limited to the institution, but
extend into the community and ramify all its
activities?
The expression of ideal of purpose and object
must be followed, of course, by the organization
of minimum requirements of service.
SOME STRUCTURAL SUGGESTIONS
The structural conditions are important but not
determining. The very best service in the world
may be housed in a structure long since considered
antiquated as to plan. There is no reason why the
congregate institution may not furnish its pa-
tients and the public very excellent service, even
though this style long since ceased to be consid-
ered first-class. But, for future construction and
expansion, a minimum standard can easily be sub-
mitted. Personally, I believe in the small one-
story dormitory cottage with few single rooms,
ample toilet and bathing facilities, unbarred win-
dows, and, so far as possible, unlocked doors. For
the thousands of chronic insane who are to spend
their lives segregated, this type offers the most
advantages and the maximum of liberties; it al-
lows a nearer approach to natural life; and this
must always be kept in mind when thinking on
this subject : the institution should always aim at
the reproduction, for its inmates, of conditions
and situations as nearly natural as it is possible
to attain. True community life is possible in an
institution, but we have not yet been able to supply
it in a degree that demonstrates its possibilities.
All classes of employees should be trained and
experienced to furnish intelligent oversight and
supervision and to become human substitutes for
bars and locks. That this can be done has been
proved too many times to permit us to waste time
discussing it academically.
The state hospital standard should provide full-
time resident physicians, dentists, pathologists,
psychologists, occupational therapeutists, direc-
tors of recreation and amusements ; it should re-
quire modern hospital equipment and facilities
for the physically sick and infirm ; hydrothera-
peutic wards, for such acute and chronic disturbed
patients as are benefited by hydrotherapy, such
wards to be in operation the full twenty-four
hours of each day and to be in charge of trained
hydrotherapists.
Mechanical restraint is wholly unnecessary and
should be excised by the force of public opinion
wherever state hospital authorities refuse or neg-
lect to govern themselves and administer their in-
stitutions by the light of so sensible and so hu-
mane a requirement.
SERVICE TO THE PATIENT
Sei'vice to the patient should include modern
diagnostic methods on his admission, both as to
his mental and his physical state, followed by
frequent progress notes and by at least two com-
plete mental and physical examinations each year
throughout his entire residence in the institution.
Only by such follow-up service can the staff know
its patients and the patients be given the chance
and the opportunity for betterment of environ-
ment, whether in the hospital or on the outside.
Many patients today have degenerated in the in-
stitution, and the time has passed when they
might have made good in free life.
HOSPITAL WARDS AND THE CHRONIC PATIENT
Wards for the sick and infirm should be in
charge of registered nurses, and those for the
chronic insane in charge of trained attendants
drilled in specific duties towards their patients.
To secure such types, the institution must main-
THE MODERN HOSPITAL
83
tain in its own walls a training school for nurses
and attendants, and it must affiliate with schools
and general hospitals conducting training courses
for nurses for general practice. There should be
an exchange of the pupil nurses between the two
types of schools and institutions. For after this
war no registered nurse's education will be com-
plete without a greater or less amount of instruc-
tion and experience with mental cases.
Employees should be housed off the wards in
buildings planned to provide comforts and social
relaxation under wholesome influences. The eight-
hour shift should prevail. Women attendants on
male wards are preferable to men, who should be
employed only to do the shaving and bathing and
as night watches.
FOLLOW-UP SERVICE AND OUT-PATIENT CLINICS
A minimum standard will require follow-up so-
cial service for the convalescent and the paroled
patient. It will provide a free dispensary, or out-
patient clinic, in the larger towns of the district
which the hospital serves, where staff physicians
on stated days can be consulted by those feeling
the need of expert attention and advice, and by
the paroled patient.
Experience, based on actual experiments con-
ducted in many hospitals, convince us that so-
called "untidy" wards, "disturbed" wards, and
the like are absolutely unnecessary. I believe
they are a reflection upon your ingenuity and in-
telligence. Reeducational methods, employment,
and occupation are all available for the treatment
of these classes and accomplish wonders when
rightly applied.
Screen rooms are relics of barbarism and no
standard should countenance them or excuse
them.
SOME PHASES NOT TOUCHED
I have not touched on diet and the serving of
meals, or on safeguards against fire and accidents,
or on the controversy between the ward and the
congregate dining room, or upon the very impor-
tant matter of records, or upon many other points
which should be considered vital details worthy
of settlement or suggestion in any standardizing
which might be undertaken.
What I have suggested does not form a com-
plete standard even on those phases which I have
touched. I have hoped that what I might write
here would furnish the basis for discussion from
which may develop better things: I might hope
that it will be the root from which will spring an
organized effort for improvement, such as has
done so much already for the betterment of gen-
eral hospitals throughout the whole country.
Someone will reply that even this much is too
elaborate and too expensive, but I say no. These
institutions are operated by the state on the peo-
ple's money. It may seem impossible, but I make
the assertion that a standard based on these sug-
gestions will not cost the people a material addi-
tion to what it now costs them.
ELIMINATE WASTE — PROVIDE SKILL
When the waste involved in the political or par-
tisan system of management is eliminated ; when
buildings, impi'ovements, and supplies are fur-
nished on merit and business principles, and not
on political expediency ; when the employee is
trained for his specific duty and is paid well
enough to enlist and retain his services, thereby
eliminating the wasteful labor turn-over; when
the ablebodied patients are all engaged in some
economic employment ; when supervision of food,
its preparation, distribution, and serving is
skilled, thereby cutting out waste ; when the power
plant has been modernized with labor, fuel, and
heat saving devices; when the medical staff is
professionalized and engaged strictly in the pro-
fession of returning patients to society and avert-
ing mental breakdown by treatment in the home ;
when these changes, and many others which logi-
cally follow them, take place, as they certainly
will when a standard is set by men and women of
national voice and appeal — then the state hospital
w'ill give service and promote a spirit of ideals at
an expense no greater than it now imposes upon
the taxpayer with no more return than a common
jail is expected to make.
Speaking at a meeting of the Church of England Zenana
Missionary Society on May 3, Dr. Charlotte Bacon, of
Keveilin, China, described the methods of the Chinese
"quack" doctor. Has the patient a pain? — then stick a
needle in, no matter where the pain is. Has he an abscess
or boil ? — then plaster it over with dirt and mud to keep
the smell in. If feeling a pulse, feel botli, for one tells
the condition of kidneys and stomach, and the other of
lungs and heart! Dr. Bacon's first operation was for
trachoma; three friends came with the patient, and two
Chinese women were beginning to be taught as nurses;
but when the doctor put out her hand to take a swab from
the bowl that one should have been holding, there was no
bowl there. Friends and nurses had fled at sight of the
first drop of blood! The little hospital now has only ten
beds, but it sometimes holds twenty patients, as well as
their friends. "Do you wonder," asked Dr. Bacon, "that
sister's face was very long when first she saw my hos-
pital?" This same sister is now carrying on single-
handed till Dr. Bacon can return, the only worker with
medical knowledge in a city of 250,000 inhabitants. — Brit-
ish Journal of Nursing.
No wind serves him who addresses his voyage to no
certain port.— Montaigne.
84
THE MODERN HOSPITAL
THE NURSES' HOME OF THE HACKENSACK HOSPITAL
An Attractive Building in Georgian Style— Brightness and Cheer the Dominant Notes—
A Generous Gift to the Community
By FREDERICK P. WASHBURN, President of the Hackensack Hospital Association, Hackensack, N. J.
rnHE nurses' home of the Hackensack Hospital is a i-esident instructor, for the instruction of nurses
J- of stone and brick fireproof construction. It
stands south of the hospital in a commanding
situation, with an extended view to the east. The
architecture is Georgian in style, and the interior
under training. It is equipped with pupils' chairs,
instructor's desk, and blackboard. Adjoining this
room is a "demonstration room" with two mani-
kins upon separate beds. A more interesting and
inviting apartment comes next
— the diet kitchen, where pupils
will be taught how to prepare
dainty dishes in an endeavor to
lure back vagrant appetites.
This room is fitted up with indi-
vidual gas appliances, also a gas
range, and pots, kettles, and
pans that tell the story of a real
housekeeper's supervision of
selection. Here is another black-
board where the demonstrator is
presumed to give free-hand
drawing of calories and other
mysteries entering into balanced
rations for invalids and for con-
valescents who manifest the ap-
petites of growing boys in base-
ball time. The laundry, trunk-
room and heating plant are also
on this basement floor.
decorations are also Georgian. The elegant and
graceful simplicity of the structure is most cred-
itable to the architects. Crow, Lewis, and Wicken-
hoefer of New York.
Comely proportions and harmony are conspicu-
ous throughout the interior. Each floor has a
wide hall running the full length of the building,
which is 85 by 36 feet, and windows at each end
give ample light even on cloudy days. Brightness
and cheeriness dominate every part, insuring to
nurses off duty absolute relief and rest from the
trying tasks in the adjoining hospital; and, in
furtherance of this desirable purpose, particular
attention has been given to making the place as
sound-proof as possible, for some of the nurses
must always be sleeping by day.
The business part of the establishment is in
the basement. Here is a classroom, in charge of
•This is the seventh in a series of articles on nurses' homes. The
first, "Nurses' Homes and Some of Their Requii-ements," by Olof Z.
Cervin, appeai-ed in January ; the second, "Kistler Memorial Home for
Nurses of Lock Haven Hospital," by V. Happersett and Louis H. Rush.
in Februai-y ; the third, "New Nurses' Home for Minnequa Hospital.
Pueblo, Colo.," by R. W. Corwin, in March ; the fourth, "The Helen
Newberry Nurses' Home," by Harriet Leek, in. April ; the fifth, "The
Nurses' Home of the Norton Memorial Infirmary," by Arthur Loomis
and .lulius Hartman, in May ; and the sixth. "Nurses' Homes— J^ Plea
for Efficiency in Their Desien." by Meyer J. Sturm, in June.
of the Hackensack nurses' ho
THE MODERN HOSPITAL
85
The main (entrance) flooi- has a suite of rooms
for Miss Stone, superintendent of the hospital, a
general writing room, a library, and a large living
room extending across the south end and opening
on to a large sun-parlor, heated in winter and
screened in summer. There is also a reception
room and several bed-rooms for nurses on this
floor. The living room is handsomely furnished,
lent gas jet in each. Accommodations are pro-
vided for thirty-four nurses.
On the upper floor there are two isolation
rooms for use in case nurses should have con-
tagious diseases. Each room has a commodious
closet. Then there are large linen closets, well
stocked and with each article carefully marked
with the name of the home.
Fig. 4. Typical bed
the furniture being the gift of Theodore J. Palmer
and his son Embury Palmer of the firm of Palmer
& Embury, New York.
Each of the nurses' rooms is furnished com-
plete to the minutest detail ; this includes writing
desk and embossed stationery. The rooms are
lighted by electricity and there is also a conven-
of the Hackensack
There are lavatories, baths, and showers on each
floor, all equipped in the most thorough manner.
In fact, there appears to be no detail overlooked
in making this a complete home for the large
corps of faithful nurses employed in the Hacken-
sack Hospital. With the exceptions noted, the
substantial construction and finish, and the com-
86
THE MODERN HOSPITAL
plete furnishings of the home, ready for the
nurses to move into with their personal belong-
ings, are due to the generosity of the Hon. William
M. John.son. He not only expended about sixty-
five thousand dollars in making the building one
of the most complete of its class in the country,
but has given to the Hackensack Hospital Asso-
ciation bonds of the value of forty thousand dol-
lars as an endowment of the home, the income
to defray the expense of its maintenance. This
relieves the hospital from all care for supporting
the institution — a free and clear gift.
A more comfortable and inviting home for the
hospital nurses could not well be conceived. Nor
can it fairly be doubted that they deserve such
a retreat to which they may retire when off duty,
free from the cares and trials of sick rooms. Here
they may thoroughly enjoy the recreative hours
in absolute rest, with attractive surroundings that
include "all the comforts of home."
METHODS OF INDEXING HOSPITAL CLINICAL RECORDS
Wholesome Influence on Hospital Work of Adequate System of Indexing — Two Methods
of Filing Histories — Card Catalogue of Diagnoses and Self-Indexing
History File
By MIRIAM BYRNE, Medical Record Clerk, Cook County Hospital, Chicago
WITHIN the last decade, many hospitals have
awakened to a realization of the value of
clinical records for research and teaching pur-
poses. This has come not only to the large hospi-
tals or to those close to the teaching centers, but
to the smaller and more remote as well, and the
results in improved hospital conditions and better
hospital work have been noteworthy; for, when-
ever the question of conserving records is dis-
cussed, the question of the value of such records
arises, and to the problem of finding the best
method of filing is added that of seeing that the
records are worth filing. The fact that no record
is worth filing unless it shows every detail, patho-
logical and clinical, which may have affected the
progress of the illness, and the knowledge that
every record is liable to close and intelligent scru-
tiny have a marked retro-active effect in promot-
ing more thorough examinations of all kinds and
care in the record-building. This wholesome in-
fluence on the work of the hospital in general ex-
erted by formal indexing of clinical records car-
ried out in suitable surroundings is very evident
in some of our better-conducted hospitals.
There are many factors to be considered in the
proper conserving and utilizing of history sheets,
but it is the purpose of this article to consider
methods of filing only in so far as they bear on the
accessibility of records for medical research.
There are two methods of filing histories with this
object in view. Under one the diagnoses are in-
dexed on cards, and under the other the histories
themselves are filed according to diagnosis. The
first method was used at the Cook County Hospital
during 1909 and 1910, but. owing to the great de-
mand for large numbers of histories and to the
small amount of clerical service available, the
other method was installed in January, 1911. As
this latter method makes it possible to take out
and replace all the histories of any disease or con-
dition in the time required to pull out the draw^er
containing them, without any preliminary listing
or choosing, the attending and resident physicians
have used the records very much more than when
it was necessary to list and assort records and
wait until they were taken out of the files. Hav-
ing used both methods and realizing the meager-
ness of information in regard to this phase of
hospital work, I have prepared the following brief
outline of both and compiled a list of all refer-
ences in English to clinical indexing of hospital
records which a thorough search discloses.
CARD CATALOGUE OF DIAGNOSES
When the clinical catalogues consist of cards,
the history is filed numerically according to the
patient's admission number and a card is written
for each disease or pathological entity by which
the patient was affected while in the hospital. For
instance, Mary Brown, who was treated for scar-
THE MODERN HOSPITAL
87
let fever complicated by acute nephritis, would
have two cards in the diagnosis catalogue. The
scarlet fever card, as illustrated in Fig. 1, would
be placed in its correct chronological order behind
the guide card for scarlet fever, and a card for
acute nephritis (Fig. 2) would be similarly placed
behind the acute nephritis guide. Anyone wish-
ing to look up all histories of scarlet fever, all
Principal Dissase
Coraplicatione
Kerne
Ago
Dates
File No.
Conditicn
Dr.
Fig. 1. Specimen card used in the card catalogue of diagnoses. This
card, used for the principal disease, is a white card measuring 3 by
5 inches.
complications of scarlet fever, all acute nephri-
tides, or nephritis as a complication of scarlet
fever, makes a list of the hospital admission num-
bers appearing on the proper cards.
Even after this preliminary selecting and list-
ing, the finding and removing of the needed his-
tories from the filing cases is a tedious process,
and when the researcher has finished his work
there remains the task of replacing them one by
Ccpplication
Principal Diaeaso
Other Coraplicatione
Keiue
Age
Dates
File No.
Condition
Dr.
second "Diseases of the Blood," the third "Dis-
eases of Bones and Cartilages." In the second
drawer, which is labeled "Diseases of the Blood,"
are placed guides with the subject headings:
Anemia, Pernicious.
Anemia, Simple.
Anemia, Splenic.
Chlorosis.
Hemophilia.
Leukemia.
In back of the "Pernicious Anemia" guide are
placed the pernicious anemia histories in order of
their arrival in the record room and according to
the serial number of that disease. On the history
of John Smith, whose case was the fifth of perni-
cious anemia, appears "Pernicious Anemia, File
No. 5," and on the card filed alphabetically under
the name "John Smith" appears "Pernicious Ane-
mia No. 5."
For the indexing of complicating diseases, the
forms illustrated in Figs. 3 and 4 are used. These
forms are the same size as the history sheets and
Fig. 3. Form used for indexing complications of a givt
according to the self-indexing system of filing histories. This sheet
corresponds in size to the history sheet.
are kept in manilla paper folders and filed with
the histories. The two folders containing the
sheets entitled "Complications of Pernicious Ane-
mia" and "Complicating Disease — Pernicious
CROSS REFERENCE SHEET
..JUxJti. CxJ^o* lA-iAii,/. .._
-H'
■rAr,iyn,uJ 5&-
/ir^jll Wl
the self-indexing system of
one. For whatever length of time anyone work-
ing on a group of histories keeps those histories
out, the files are incomplete and disarranged.
HISTORIES SELF-INDEXED
Under the other method, which originated at
Bellevue Hospital and is known as the Bellevue
Hospital System, the histories are placed in verti-
cal filing drawers behind guides arranged accord-
ing to an accepted nomenclature. If the Bellevue
nomenclature is used, the first drawer is labeled
"Abnormities and Congenital Malformations," the
Anemia" are placed directly in front of all the per-
nicious anemia histories and directly behind the
guide card labeled "Pernicious Anemia."
Anyone wishing to see the records of any dis-
ease or condition finds them all in one place with
supplementary lists already prepared and avail-
able at a moment's notice. It is not unusual for a
researcher to refer to groups of histories some-
times totaling several hundred again and again
during a period of many months, and under this
method a whole group or any part of it may be
taken out and replaced daily and the files kept
complete and in good order.
THE MODERN HOSPITAL
NOMENCLATURE
Although absolute uniformity in the terms em-
ployed in diagnosis is recognized as essential in
medical statistical inquiry, it is a regrettable truth
that the various hospitals which have attempted
to use their records for research purposes, instead
of adopting some one nomenclature and making it
standard, have in almost every case compiled lists
and arranged classifications of their own. The
Bellevue Hospital Nomenclature, compiled in
1903, revised in 1909 and in 1911 again revised
and made to conform to the International Classifi-
cation of Causes of Death, is more universally
used than any other. Because of this and its rec-
ommendation by the Census Bureau and by the
committee on nomenclature and classification of
diseases of the American Medical Association^ it
may be considered more nearly standard than any
other list of diagnoses published in this country.
BINDING
It is customary at some hospitals to bind the
histories at convenient intervals. The stacks of
bound volumes make an impressive-appearing
library, and the possibility of a record being lost
or destroyed is lessened. The expense, however,
is considerable, the bound volumes are not so
easily handled as separate histories, and the fre-
quent requests for histories in the same volume by
different individuals is a marked disadvantage.
Hospital Librarian (read at the 14th meeting of the Med-
ical Libi'ary Association, May, 1911).
Hollings, Byam: Record Keeping at the Massachusetts
General Hospital (The Modern Hospital, Feb., 1914,
p. 94).
The Bellevue Hospital Nomenclature of Diseases and
Conditions, 1903, Revised 1911, Nevi' York.
Manual of the International List of Causes of Death,
Second Revision, Paris, 1909 (Government Printing Office,
Washington, 1911).
International Classification of Causes of Sickness and
Death, Revised by the International Commission at the
Session of Paris, July 1 to .3, 1909, for Use Beginning Jan-
uary 1, 1910, and Until December 31, 1919 (Government
Printing Office, Washington, 1910).
List and Classification of Diagnoses for Use in the
University of California Hospital (University of Cali-
fornia Press, Berkley, 1916).
Classification of Diseases, Massachusetts General Hos-
pital, 1916.
List of Diseases and Pathological Conditions, Stanford
University Medical Department Including Lane Hospital,
San Francisco Cal., February, 1913.
Post, Wilbur E.: A Classified Nomenclature of Diseases
Designed for Use as a Diagnosis Index in the Central Free
Dispensary, Rush Medical College, 1909.
Advanced British Dressing Station on Newly Captured
Ground
In a very short time after the capture of new territory,
not only do the infantry and the artillery move up to
maintain the new position, but the first aid dressing sta-
tions also take their places on the newly captured ground.
REFERENCES
A Description of the System of Recording and Filing
Histories used in Bellevue and Allied Hospitals, New
York, 1905.
Myers, G. W.: Care of Hospital Records — According to
the Method of the Massachusetts General Hospital, Bos-
ton, Mass. (Internat. Hosp. Rec, 1911).
Whitney, J. L.: The Nomenclature and Classification of
Diseases in Use in the University of California Hospital
(Boston Med. and Surg. Jour., Nov. 18, 1915).
Kilgore, E. S.: Clinical Records in Relation to Teaching
and Research — A Plan to Promote Conservation and Utili-
zation of Material (Boston Med. and Surg. Jour., Nov. 18,
1915); Clinical Records (I)— Outline of Case Histories
(California State Jour. Med., Nov. 1915) ; Clinical Records
(II)— Blank Forms (ibid., Dec, 1915); Clinical Records
(III) — The Later Clinical Notes and List of Abbreviations
(ibid., Jan., 1916); Clinical Records (IV)— The Ward
Reference Book (ibid., Feb., 1916).
Clark, Genevieve L.: Clinical Records (V) — The General
Oversight and Filing of Records (California State Jour.
Med., March, 1916).
Brotherton, James S.: Hospital Clinical Records (Jour.
Am. Med. Assn., April 19, 1913, p. 1205).
Howland, Joseph B.: Hospital Records (The Modern
Hospital, November, 1914, p. 288).
Bell, J. Finley: Method of Keeping Case Records for
Small Hospitals (Med. Lib. and Historical Jour., 1905, III).
Myers, G. W. : Hospital Records in Relation to the
llntroduction to Manual of International List of Causes of Death.
Second Revision, Paris, 1909, Jour. Am. Med. Assn., July 8, 1911.
Copyright Underwood & Underwood. New York.
In this New Zealand official photograph, an advanced
British dressing station has been moved up and the
wounded are being treated. The German prisoners help
in bringing in the wounded. A view of a former "no
man's land" is given.
Many are the beings in us that are never born; many
the lives beating their wings against our bars, seeking a
freedom we forbid. Until some enthusiasm asserts us, we
do not realize how partially, how timidly we have lived.
No longer let us keep self under lock and key, niggardly
doling it out, but freely outgive it that at last we may
attain full size.— Stephen Berrien Stanton, "The Hidden
Happiness."
THE MODERN HOSPITAL
89
HAS EVERY HOSPITAL AN INHERENT RIGHT TO AN INTERN?
Misunderstandings by Hospitals in Regard to
Approval for Intern Education— Duties
By J. M. BALDY, M.D., President Pennsylvania Bureau
THERE are so many misunderstandings by hos-
pitals in regard to the question of internship
and their so-called rights in this matter that it
has been thought worth while to discuss a few
points relative thereto.
As a basis for a discussion it may be said that
no hospital has an inherent right in the matter
of internship any more than it has an inherent
right to a superintendent, to a head nurse of its
training school, to an engineer, or to a cook. Hos-
pitals have the right to purchase the services of
any one of the above mentioned employees. They
have the right to purchase the services of an
intern. In the case of the above-mentioned em-
ployees, if hospitals wish to secure an individual
competent to fulfill the needs of that particular
department, they must pay the price. It goes
without saying that, if they need the services of
an intern, they must pay the price. The usual
price asked of a hospital for the service of an
intern is his education, and consequently it fol-
lows as a corollary that any hospital that wishes
to buy the service of an intern must be able to
qualify on the possible educational points neces-
sary for this purpose. In Pennsylvania the Com-
monwealth has laid down a very definite and posi-
tive standard, both as to equipment and as to
educational advantages, to be offered in return
for the service of an intern. It is therefore simply
a question as to whether or not a hospital can
pay the price, as to whether it has a right to an
intern. There is no such thing as an inherent
right, an assumption which is too often assumed
by hospitals.
There is no great hardship to any hospital not
being approved for intern teaching, even if it
desires a resident physician on its service. There
are a number of possibilities of fulfilling this need.
The number of interns who are required to take
a service in an approved hospital are only a por-
tion of the total number graduated from the
Pennsylvania schools in any given year. In addi-
tion to these there are a few graduated from
schools outside of Pennsylvania who intend to
take the Pennsylvania state examinations and
practice medicine in Pennsylvania. The total
number of these compared with the total number
of students graduated in the country at large is
probably not more than 10 percent or 15 percent,
and hospitals not on the approved list have avail-
Internship — No Discredit Attached to Non-
Which the Hospital Owes the Intern
OF Medical Education and Licensure, Philadelphia.
able for their services the other 85 percent or 90
percent of young medical graduates of the coun-
try. Furthermore, they have available for their
services young men who have already spent a
year of internship in an approved hospital and
who are about ready to start the practice of medi-
cine. Probably 50 percent of the gi-aduates in
medicine are boys of moderate means who have
exhausted all of their available funds during the
course of their education and who would be only
too glad to accept the position of "hospital resi-
dent" for a year or two at a decent living salary,
thus making it possible for them to extend their
hospital experience, as well as to lay up a few
dollars with which to assure themselves their first
year's expenses when they start in to practice.
This establishment of the salaried resident physi-
cian is peculiarly adaptable for hospitals not
assuming the teaching function. From these
sources any unapproved institution may draw, and
in no way interfere with the ambition of the
Commonwealth to secure for its coming practi-
tioners the proper standard of practical education
before they are allowed a free hand upon the
community.
It is a grave question whether or not small in-
stitutions obtain any advantage from the service
of an intern. Usually hospitals of from twenty-
five to fifty beds are in small communities where
the doctors of the medical and surgical staflF are
in close touch with the institution at all times; a
phone leads directly to the office and bedroom of
every member of the staff, with every member
within such easy reach as to be able to be in the
hospital as often as required. The almost usual
routine of such a hospital, where an intern is em-
ployed, is that the intern is practically allowed
to run the institution ; as a matter of fact, he is
there more for the convience of the doctors than
he is for the efl^cient working of the hospital. The
salaried resident physician accomplishes the same
result as does the intern and has the great ad-
vantage of allowing the institution to demand
competency and the full time of the doctor for
the service of the hospital. In a large number of
these institutions the intern is allowed entirely
too much freedom for the interest of the patients,
and he receives little or no instruction from the
medical and surgical staff.
Some of the most efficient medical and surgical
90
THE MODERN HOSPITAL
institutions in the state have been in the past
years, and are at present, conducted without the
service of any intern, and so efficiently is the
service conducted by the closer personal attention
of the medical and surgical staff that an intern
would be considered a nuisance and in the way.
Many such institutions seriously and rightly ob-
ject to allowing a young man too much freedom
in the treatment of the patients.
No discredit whatever attends any medical in-
stitution which is not approved for intern educa-
tion. The reason dominating the desire of not a
few hospitals for approval for the education of
an intern is the fear that their non-approval
means discredit. If one were going to give a con-
tract for shovels and pickaxes, and sent his agent
into the field to seek out and recommend to him
such factories as could fulfill his demands, and
this agent happened to go, among others, into
the Carnegie mills, which were producing Bes-
semer armor plate for the navy, and, in rendering
his report of available steel manufacturing plants
to his employer for the purchase of pickaxes and
shovels, failed to include the Carnegie mills,
it could hardly be complained by the Carnegie
plants that they were not included in the list so
reported and approved, and that thereby they
were discredited as a steel plant. It would simply
mean that the Carnegie plants were not produc-
ing picks and shovels, and there would not be the
thought in the mind of a single individual in the
Commonwealth that the Carnegie plant was not
producing competently that for which they were
organized, namely, the production of armor plate.
And so it is with hospitals. The Commonwealth
is not seeking for armor-plate hospitals. It is
seeking for and approving hospitals which have
all the facilities, both physical and personnel, for
the education of the intern on a certain standard ;
its approval simply means that such an institution
fulfills that need, nothing more and nothing less.
Institutions have sought approval for intern ed-
ucation because of the fact that they have con-
ceived that it may in some mysterious way inter-
fere with their state appropriations. This again
is a fallacy. The Commonwealth, in contributing
money to medical institutions, is doing so on the
basis of the charity work done by the institution
for the citizens of this Commonwealth. That
service is evaluated, not by the Bureau of Medical
Education and Licensui'e, but by another bureau,
the State Board of Charities, and the approval or
disapproval of the Bureau of Medical Education
and Licensure for intern education has no bear-
ing whatever on the approval of the State Board
of Charities for the amount of charity work done ;
and no institution is in any way affected as far
as its charitable financial work is concerned. As
a matter of fact, if a weak institution which has
become fairly competent in the carrying out of
the one function which it was fulfilling were to
take on the dual function (the additional function
of education of the intern), it might readily be-
come so inefficient in the conduct of its purely
charity work as to weaken its claims on charitable
funds for charity work performed.
It would be a grave mistake on the part of the
state to demand that all hospitals accept interns
into their service, especially after having laid
down a certain standard as a minimum competent
standard for instruction of the intern. Hospitals
are usually established by their founders for the
fulfillment of certain specific functions. A cer-
tain need has grown up in a given community.
Influential members of the community have sup-
plied the funds and the energies sufficient to de-
velop an institution for that particular need.
They have developed this institution after years
of hard struggle to a point of efficiency. They are
perfectly satisfied with what they have accom-
plished; the need as seen by them is wholly ful-
filled and the possible funds available are fully
absorbed. For the Commonwealth to step in and
say that such an institution shall now assume a
second function, an educational function, one re-
quiring vast changes in equipment and personnel
of the staff, would so absorb the available funds
and energies of the institution as to cripple it in
its effort to carry on two functions and would
make the carrying out of both of them inefficient.
Such compulsion would force the institution in
only too many instances to degenerate from one
of great efficiency to one of utter inefficiency on
account of the lack of interest by those in manage-
ment (something having been forced upon them
in which they had little or no interest) , as well as
on account of the division of funds which were
only sufficient for carrying out the one object. In
the Commonwealth of Pennsylvania no such mis-
taken idea is held by the state. The administra-
tive body fully realizes the situation and believes
that in the case of large numbers of hospitals
not only would it be foolish for them to attempt
to qualify for approval for the intern education,
but it would be fatal to their interests. It is in
no way necessary for any hospital so disinclined
to depart from its past methods of giving service
to the sick of their community; nor will it at any
time be necessary so to do. There are quite a
sufficient number of hospitals in the Common-
wealth which are able and willing, by minor
changes in administration and equipment, both
THE MODERN HOSPITAL
91
of which they can well afford and the doing of
which will bring no hardship to the institution,
to absorb all of the available material for intern-
ship. As a matter of fact, there are too many
such institutions. The number of graduates of
medical colleges are today 33 percent less than
they were ten years ago. Pennsylvania has an
ever-increasing number of hospitals. Conse-
quently, the available material for internship is
becoming proportionately scarcer and scarcer.
Not only is this so, but large numbers of hospitals
which in the past have been small, or for some
reason or another have not desired the use of an
intern, are now expanding and are helping to
absorb the available number of young medical
men for this service. The consequence of these
multiple forces is that, if it were admitted for a
moment that every hospital had an inherent right
to an intern, there would not be the possibility of
parceling out a man to each institution.
A clearer understanding of the situation will
probably be obtained by a frank discussion of the
whole subject; and that is what is being at-
tempted. It is primarily the intention of the Com-
monwealth to secure for the intern the best pos-
sible education. From this viewpoint, its interest
in the hospital is purely secondary. This is not a
matter in which the interest of the intern is alone
considered. If it were, the Commonwealth would
have no function in the matter, as it is not con-
cerned in class legislation. The interest the state
has taken in the matter is the interest of the
whole people of the Commonwealth; that each
and every individual, however poor he may be,
shall be assured when in the future he employs
a physician that he and his family shall receive
a competent service. Without the stamp of ap-
proval of the state, the citizens have no assurance
of the competency of the service offered them.
The effort is that the state approval shall stand
as a stamp of efficiency; a minimum standard, of
course, but a safe one withal. Consequently, it is
perfectly proper that the Commonwealth shall say
that the intern education shall consist of a certain
definite line of instruction given in institutions
which have definite physical and educational qual-
ifications by means of which the standardized in-
struction may be given. The Commonwealth,
therefore, having laid down the physical qualifi-
cations and the line of instruction, must recognize
any institution within its borders which can fairly
show that it is able to and does live up to the ap-
pointed standard. But the natural corollary of
this is that no institution which does not furnish
the standard which is demanded, both of equip-
ment and of service of their staff, can expect to
be considered in the matter. It must, therefore,
be realized that the state can have no active in-
terest in furnishing every hospital with an intern ;
the fulfilling of that need, if the need exists, is
peculiarly one which concerns the hospital itself,
just as does the supplying itself with any other
employee.
It may be truly said that the furnishing of the
physical equipment, as compared with the insur-
ance of competent instruction, is by far the
easier of the two propositions. Many an insti-
tution which is physically equipped, according to
the state standard, is utterly inefficient in its
teaching capacity on account of the lack of proper
or competent service of its medical and surgical
staff. Any institution of seventy-five beds may
be perfectly competent to conduct proper and
comprehensive intern teaching, but a medical and
surgical staff of a hospital comprising a thousand
beds may utterly disqualify that institution as
competent, both on account of the organization of
the various services and on account of the lack of
ability or willingness of the members of the med-
ical and surgical staff themselves to take the
trouble to do that which is necessary in order to
bring about a systematic and proper course of in-
struction. The service of one or two excellent
members of a staff may be totally outweighed by
the indifference or incompetence of othei's.
Following this thought and reverting to the
state's interest in any hospital, it goes without
saying that the hospital which is compelled to be
so organized as to teach the intern satisfactorily,
is giving a maximum assurance to the community
that it is offering a proper service to its patients ;
and the corollary to this is true, that the medical
and surgical staff which is so slovenly and so
careless in its duties to the intern as not to give
a satisfactory service is also equally slovenly and
careless in its handling of the patients.
It has been complained by hospitals that they
need the services of an intern ; that they have sev-
enty-five or one hundred beds and the hospital
needs an intern. They would like to have one,
or possibly two, interns. This usually is the sum
total in such an institution of the conception of
its duties to the intern. The mere suggestion of
such a proposition carries with it the knowledge
that the intern in an institution of that type would
not receive a proper service from the educational
standpoint. What that hospital wants is an em-
ployee to do its work. What that hospital should
do is to pay, in dollars and cents, the full value of
the service of such an employee by obtaining a
resident physician and then demanding his full
time for its own services; and not to attempt to
92
THE MODERN HOSPITAL
give half of the time of the hospital and of the
hospital staff to the instruction of the intern. This
is the remedy at the service of any hospital which
feels. that it needs the service of a physician re-
siding in the institution, and which is unable to
secure interns on the merit of the service ren-
dered and the educational advantages offered.
Many hospitals imagine they are offering a fine
opportunity because of the wealth of material
passing through their wards, and many interns
are deceived by the same token. The state con-
ceives differently and considers the personnel and
efforts of the staff far and away of the greater
importance. Consequently, any hospital that can-
not or does not control its staff in these matters
cannot be considered as having a satisfactory
service to offer in return for approval for intern
teaching.
The whole question of internship and what it
means has so often been misconceived that it may
be of aid to hospitals to have the matter put fairly
and properly before them — hence this discussion.
It has been thought because of the fact, in the
instance of a number of institutions whose man-
agers have discussed the matter with members of
the Bureau of Medical Education and Licensure,
that the results to those interested in the institu-
tions have been so eminently satisfactory on ac-
count of the proper viewpoint having been put
to them, that the discussion might be helpful to
others. Quite a number of institutions eager for
approval for internship, when the matter has
been put before them in the above form, have
wisely given up the effort to qualify and have
appeared grateful for advice which has relieved
them of much embarrassment, with the additional
result of reorganization in points of management
which has brought to their community a vastly
more efficient medical and surgical service than
had before obtained.
It may be said, with little fear of contradiction,
that the greatest trouble with hospitals has been
the lack of proper sources from which managers
could derive adequate advice in regard to their
various functions. The Bureau of Medical Edu-
cation and Licensure stands ready at any time to
assist any board of managers in regard to these
matters.
FLOATING HOSPITAL OF ST. JOHN'S GUILD AGAIN AT WORK
The Specially Designed Steamer Helen C. Juilliard Ready and Serving Sick Poor Chil-
dren of New York — Seaside Hospital as the Shore Institution
By JAMES W. BECKMAN, New York
HOW THE Idea Originated. — Forty-four years
ago George F. Williams, editor of a large
New York newspaper, was walking through a
park one hot summer day. In those days, as now,
all grassy plots were decorated with the sign,
"Keep off the grass." A little barefoot newsboy,
denied nature's greatest gift — the green grass,
air, and sunshine of the country — was playing on
the grass in the park. Just as the editor ap-
proached the boy a policeman ordered the little
chap off. When he stepped on the burning pave-
ment, his small bare feet were blistered, and he
cried with pain. It was very sad. Yet the police-
man was not to blame. He had done only what
city laws required him to do.
Editor Starts the Movement. — The tears of
the barefoot boy touched the heart of this busy
editor, and he thought, "Why can't something be
done for these poor little children?" Then the
idea struck him to hire a boat and take the little
ones of New York out in the country for a day,
and let them play on the grass to their hearts'
content and breathe all the fresh, pure air of the
country that their little lungs could hold.
St. John's Guild Takes Work Over. — And so
this editor chartered a barge and all the little ones
who could be rounded up were regularly taken on
trips. This was in 1872. The following summer
the work was taken over by St. John's Guild,
which has continued it to this day. The service
has been greatly extended. Owing to the number
of poor children, it was necessary to restrict the
trips in 1887 to those who were ill and in most
need of the benefit that an outing gives. Thus
began the first movement of this kind for the
benefit of children.
First Hospital Ship Made From Old Steamer.
— The present floating hospital of St. John's Guild,
the Helen C. Juilliard, is the third one which the
guild has operated. The first one was made from
the hull of the old steamer "River Belle," which
had burned to the water line in the sound. It was
renamed "Emma Abbott," in honor of the famous
grand opera singer of the day, who donated the
money for the boat.
The second boat was launched May 4, 1899. It
was named "Helen C. Juilliard," in honor of the
donor, Mrs. Augustus D. Juilliard. This boat was
thought to fulfill every requirement at the time it
was put in commission, but it is surpassed in
THE MODERN HOSPITAL
93
every respect by the present "Helen C. Juilliard,"
built with another donation from Mrs. Juilliard.
New Boat Is Model ok Its Kind. — The present
boat has four wards, whereas the old one had
only two. They are situated on the front upper
deck of the vessel, where there is abundant light
and air. There are rooms for operation, irriga-
tion, instruments and bandages, and a plant for
sterilizing water. There is a small mortuary in
case of sudden death of any of the children. Al-
though many of the babies which are received by
the floating hospital are at death's door, it has
won a reputation for saving the lives of the little
ones, and it is seldom that a death has ever oc-
curred on board, although no sick babies were
ever rejected. There is a ward with thi'ee beds
for mothers. A special convenience for both
mothers and babies is an iron frame on the backs
Can Now Handle More Serious Cases. — The
improvements on the "Helen C. Juilliard" enable
more serious cases to be cai'ed for than was
possible on the old ship because a more definite
hospital angle has been carried out in the con-
struction. The staff of this boat consists of six
nurses, a superintendent, matron, and phy-
sician, with comfortable quarters for all. In the
old boat there were many dark corners, but this
has been remedied, as this boat sits high in the
water, and there is light and air everywhere. The
bed rooms for mothers and children are large and
convenient. There are arrangements for various
kinds of baths, fresh water, salt water, either hot
or cold, and also regulated temperature baths for
medicinal purposes.
Seaside Hospital. — Seaside Hospital is situ-
ated on the shore at New Dorp, on Staten Island,
^
m^mmmmmtm^^i^^imm^^^S^^^
Fig. 1. Helen C. Juilliard Floating Hospital.
of the long benches on one of the decks, in which
are swung little hammocks, where babies, not sick
enough to go into the wards, can be placed.
The boat is a model hospital in every way. It
is 215 feet over all in length, with a beam of 43
feet. It has a legal carrying capacity of 2,400,
but the number has been limited to 1,200 to pro-
vide for better service.
Built at Cost of $125,000. — The ship was
built and equipped at a cost of $125,000, which
was donated by Mrs. Juilliard, who died only a
short while before the new ship was complete for
service. Her last hours were cheered by the fact
that the new boat would soon be performing its
mission in relieving the sufferings of poor chil-
dren. The ship is especially designed for its work,
and is provided with every modern convenience.
It has electric light and steam heating plants,
which can be used in winter as well as summer
if found necessary.
just across the Lower Bay from Sandy Hook. The
salt waves wash on two sides of it, and at one
corner there is only the sidewalk and the retaining
wall between the hospital and the whitecaps. In
front is an ideal sandy beach, with several hun-
dred feet of shallow water, which makes it per-
fectly adapted for children to bathe in. The air
comes off the ocean, pure, salty, and invigoi'ating.
There are five long wings to the hospital, which
give it a star shape. The sides are practically all
glass. The structure itself is of steel and concrete
construction, but its architecture is simple and
beautiful.
Screened Porches Keep Flies From Babies. —
All around the wings of the hospital are big
screened porches, so that flies and mosquitoes are
kept from the babies. They can be taken out on
the porch and there enjoy, without molestation,
the sunlight and open air of the great outdoors.
The ends of the wings are big, glass-inclosed ro-
94
THE MODERN HOSPITAL
tundas, which are used as sun parlors for the
little tots.
The entire plan, design, and detail of the hos-
pital is as modern and advanced as its general
architecture. From operating room, dental room,
and laboratory to diet kitchen, everything is ar-
ranged in a remarkably efficient manner. The
Fifi:, 2. One of the wards on the Helen C. Juilliard.
hospital is exclusively for babies of the poor, but
children of the rich could not secure better accom-
modations. Here all that nature and science can
give are bestowed on the helpless little sufferers.
When the child is brought to the hospital, it is
taken to the waiting room, where it waits its turn
to be looked over in the examining room. If it is
only ill and not suffering from a contagious
disease, it is registered in the register room and
admitted to the hospital.
Mothers and Children Given Baths. — The
patients are then sent to the bath rooms to be
properly bathed by the nurses. The mothers and
the larger children also receive baths. Usually
the mothers need the benefits of a thorough scrub-
bing as in the case of the children they have so
sadly neglected. When mothers and children are
received in the hospital, their clothing is taken
from them and kept until they are discharged. The
hospital provides clean, sanitary garments while
they are in its care. When they leave, their old
clothes are returned to them thoroughly sanitary.
They are then assigned to various wards, where
they are under the close observation of graduate
nurses day and night. A clinical chart and com-
plete notes are kept on all cases, and these are
preserved for statistical reference.
Doctors Prescribe for Each Case. — At inter-
vals a doctor makes the rounds of the wards, sees
each individual case, and prescribes for it as may
be necessary. The patient is kept as long as the
hospital thinks it can be of benefit and no time
limit is set ; all depends on the child's needs and
what can be done for it. If the child should be
taken seriously ill, the parents are immediately
notified by telephone or telegraph, and they can
come at any hour, day or night; otherwise the
regular visiting day is Sunday.
Thorough Equipment for Operations. — The
operating cases are few, but the hospital is thor-
oughly equipped for any emergency. A large
supply of sterilized dressings, instruments, etc.,
is always on hand in case of necessity. They
receive many cases which require constant dress-
ing. When an operation is necessary, the child
is anesthetized and prepared for the operation in
special etherizing room. It is then brought into
the operation room and placed on the table, where
the operation is performed. When the operation
is over, it is taken back into the recovery room,
where it is allowed to come out from the anes-
thetic before it is taken back to the ward.
The opei-ating room is equipped with the latest
mechanical conveniences, and practically every-
THE MODERN HOSPITAL
95
thing operates mechanically — sterilizers, scrub-
up basins, tables, faucets, etc. The hands are not
required to operate any of the apparatus, as it is
all done by foot and knee levers. The large steril-
izers for the larger instruments, pans, etc., are
operated by hydraulic pressure. Likewise, every-
thing in the room in which the nurses prepare for
operations works mechanically. There is almost
perfect sanitation in every respect, and hence
there is practically no possibility of infection.
»*-
ly^
Fig. 4. Hammocks for babi*
the Helen C.
Large Amount of Laboratory and Dental
Work. — Considerable laboratory work is done, for
which there is a complete equipment. There is
also a fully equipped dental office, in which the
teeth of children are put in good repair. Caring
for the children's teeth is a feature of the work ;
the older ones are taught and made to take proper
care of their teeth, as are also mothers who re-
main with the children.
Expert Dietitian Prepares Food for Babies.
— All the feedings for the babies are made in a
fully equipped modern diet kitchen, with an expert
dietitian in charge of all work. Every bottle is
sterilized before it is used, and the supplies are
kept in a refrigerating room. The cooking is done
on electric plates.
In case a child should be taken with a contagious
disease, there is an isolation building, in which
the case can be isolated and the other children
kept free from the contagion. There are abundant
toilet rooms, all fitted with the most modern in-
stallation.
How the Babies Are Bathed. — There are ele-
vated bath tubs in a room in which mothers are
taught how to bathe their children. Not only do
they bathe the child thoroughly, but they teach
its mother how to care for it after leaving the
hospital. There is also a large tub for the mother
to take her bath after her lesson of bathing the
baby. Thermostatic mixing valves automatically
regulate the heat of the water in which the baby
is bathed. A nurse accustomed to hot water might
not be able to tell by the feel of it that it is too
hot for the baby's tender skin, and all possibility
of scalding a child is thus prevented.
Child Is Put in Warm Clothes After Bath.
— While the child is being bathed, clean clothes
are placed in a warmer, so that it has warm gar-
ments after its bath. The child's bath room is
fitted with small tubs, the little ones being bathed
on a drain or bathing board and then dipped in
the tub.
Where the Children Are Procured. — Social
service w'orkers throughout the city visit the
various hospitals, milk stations, dispensaries, etc.,
settlement houses, tenement houses, and various
other places in search of cases they think would
be benefited by a stay at the Seaside Hospital.
These little patients are referred to the Seaside
Hospital, which sends doctors and nurses to see
the cases and examine them for any signs of con-
tagion. If none are found, the cases are accepted
and brought to the hospital, where they are sub-
jected to another more thorough examination
before they are admitted. Complete records are
made of all cases coming in, which continues until
discharged.
Take the Mothers, Too. — In order to secure
the sick baby for treatment, they take the mother
and any of its brothers and sisters under six years
of age ; it is necessary to do this because the hos-
pital is situated a long way from the homes of the
children. In this way the baby is cared for and
put on the road to health, while the mother is
taught how to take caz'e of the children, so that
they will be healthier in the future. The whole
family is put in line for new and better things.
During July and August the children are
brought to the Seaside Hospital on the floating
hospital. The big hospital boat leaves three piers
in Brooklyn three days each week, and three piers
in New York the other three days. No trips are
made on Sunday.
In the months of June and July particularly the
children are allowed to go in sea-bathing, weather
permitting, on every day except Sunday. A guard
in a bathing suit is always on hand to take care
96
THE MODERN HOSPITAL
of any emergency that might arise. There is also
a nurse ready to render first aid should the oc-
casion arise.
Complete Staff and Equipment. — The reg-
ular staff at the Seaside Hospital consists of four
physicians, a dentist, superintendent of nurses,
with an assistant on day duty and another on
night duty. Each ward is under the supervision
of the most capable graduate nurse that can be
all do well to follow this example. Dishes are
washed by a mechanical dish washer. On the
inside are circulating pumps which force a soap
solution over the dishes from all angles. As the
dishes emerge from the washer they are sprayed
with hot water and dried by evaporation.
A chute for soiled linen carries the .soiled ma-
terials to a receptacle in the basement; after the
clothes are laundered, they are brought up to the
main store room, where
they are assorted and put
away to await requisitions
from the various wards.
Three seamstresses are con-
stantly kept busy mending,
sewing on buttons, etc.
There are several store
rooms for various things,
such as bed clothing, etc.,
secured. Each of the five large wards is a
wing, with a large, well-screened porch on
each side. The beds can be moved out on this
porch, and the baby can lie or play entirely
free from mosquitoes and flies. The wings
are so situated that they get either the morn-
ing or afternoon sun.
Children Taught in Kindergarten. — The
end of each wing is a large sun parlor, in
which a kindergarten school is conducted to
teach the children different kinds of work.
Honor Table for Good Behavior. — The pa-
tients' dining room seats 125 to 130 people. In
the center is a big round table. This is the honor
table, and the little ones who have distinguished
themselves by specially good behavior are per-
mitted to eat at this table. It is an honor they all
prize and hope to attain. In addition to this, there
is a special room in which they serve children
who, for various reasons are not permitted to eat
in the dining room or in the wards.
Dishes Are Washed Mechanically. — The
kitchen is situated on the top floor of the hospital
instead of in the basement. Thus all the heat and
odors from it float away on the breeze and none
get into the hospital. Hospitals and hotels would
Fig. 6— Seasoned sailore on the Helen C. Juilliard.
and sanitary closets are at convenient corners, in
which the sweepings are placed to be removed
and destroyed.
The Doctors' Suite. — There is a suite of five
rooms for the doctors, with sitting room and
baths, and two toilets with tub and shower baths.
Officers and Trustees of St. John's Guild.
- — The most prominent and representative people
of New York are in charge of St. John's Guild.
The trustees and officers are all men of prominence
in their respective lines, and many are nationally
famous business men, financiers, physicians, and
professional men.
Red Tape Replaced by Business Methods. —
These men bring to the management of St. John's
Guild the most efficient business methods that
THE MODERN HOSPITAL
97
American system has to offer. The result is a
charitable organization without red tape, that
does its work in a direct, efficient, businesslike
manner. Necessity is the only requirement to
secure the help of the guild. Quibble and useless
and embarrassing questions are never indulged
in. St. John's Guild pre.sents a system of busi-
nesslike management of organized charity that
it would be well for other similar organizations
to follow.
THE GREEN OPERATING ROOM AT ST. LUKE'S HOSPITAL, SAN FRANCISCO
Glare the Crux of the Lighting Problem — Li^ht From Below the Source of Fatigue —
Reason for the Selection of Green — Importance of a Flat Surface
By harry M. SHERMAN, A.M., M.D., F.A.C.S., San Francisco.
EVER since the donors of the new St. Luke's
Hospital in San Francisco built a green oper-
ating room at my suggestion and I wrote a de-
scription of it, I have been waiting for a better
study of the matter of the colored operating room
than I had given. This was because I knew
nothing of the effect of colored walls beyond what
my own e.xperience had taught me, and it seemed
to me that architects and decorators and the elec-
tric lighting men should know more, and should,
taking my suggestion, be able to improve upon
it and find the best possible color in general, or
the best possible color for each separate place
where a hospital was to be built. Therefore I
sent reprints of my paper and copies of photo-
graphs of the operating room to as many technical
journals and magazines as asked for them, so that
the plan might have the widest publicity.
If the colored room was not discussed, I thought
that someone who believed in white operating
rooms would take up the question. Now, this last
is what has happened, and Dr. William Lee Secor,^
of Kerrville, Texas, has described his white oper-
ating room.
Really Dr. Secor and I are struggling with the
same question, and that is the glare, and I have
no doubt but that the sun can give as great a glare
in Texas as it can in California. This much we
have in common. To settle the question, 1 let into
the room through unground glass all the light
that can get there. I arrange for the reflection
from white encaustic tiling of all the light that
strikes the wall above the six-foot line from the
floor, and the same is true of the ceiling, which
is a very pale cream color. This is the light that
can shine into a wound, which is where I want it.
All the light that can be reflected upward from the
lower part of the wall and from the floor and
can then shine into the operator's face and eyes
I extinguish by the dai'k green wainscot and floor,
and I use dark blue sheets and towels and gowns
for the same purpose, the blue material replacing
the original black because of its being a pleasant
color instead of the absence of color. This seems
to me to be a simple and economical method, for
there is no waste of useful light and there is
quick extinguishment of useless light.
I am obliged to believe that Dr. Secor has
adopted an extravagant rather than an econom-
ical method, for he arranges to let in light
"through expensive ground glass windows," and
he lets in so much that the eyes must be protected
from the glare from overhead as well as from
below by peaked Mayo caps and by amber spec-
tacles. This means that all in the operating room
are in an overilluminated place and are subject
to extra fatigue by the fact, for their skins are
being bombarded from every side by light rays,
and with these must go heat rays and actinic rays.
It has been recognized in industrial and com-
mercial enterprises that physical comfort of work-
men conduces to improved work with fewer
spoiled articles and a larger output, and also with
a minimum of accidents. Henry A. Gardner,- in
the paper quoted by Dr. Secor, points this out and
adds that "in some factories paints having a
slightly greenish or other tint would be desirable,
since a small amount of some colors may reduce
the glare, but will not materiallj^ reduce the illumi-
nation." Obviously the thing to be desired is the
maximal illumination with the minimal glare.
Glare is an excess of light on the object looked at
or in the environment, so that the retina is over-
excited and fatigued. By as much as the light is
in excess it overfatigues, and by as much as it
overfatigues it is a disadvantage. Therefore it
is that the light that can shine up from a floor
or wainscot should be extinguished by tinting or
coloring both floor and wainscot. Secor has
quoted the ai'ticle showing how little glare can
come from these colored surfaces.
The selection of the color for my room was
made on the basis of the complementary charac-
=Gardner. Henry A.: The Light-Reflecting Value of White and
Colored Paints, with a Discussion of Their Relation to the Lighting of
Factories, Schoolrooms, Public Buildings, etc., .lour. Franklin Inst.,
Januar>', 1916.
98
THE MODERN HOSPITAL
ter of green to the red of the blood. Hering has
shown that in pure red there is no green, and in
pure green no red ; that is, these colors cannot be
perceived at the same time in the same color —
they are mutually exclusive so far as sensation
is concerned. Therefore the eye, looking back to
the wound after a glance across the room, can
carry none of the green impression from the floor
or wainscot with it. Even if light from the floor
or wainscot should be reflected into the wound, it
could not illuminate it, for green light would be
extinguished in a red wound.
But, even if green had not the special relation
to red that it has, it still would be the first or one
of the first colors to choose, because of its place
in or near the middle of the spectrum. Landon
and Meckel and Risley ' all agree in this — the de-
sirability of selecting a color from the middle of
the spectrum. Meckel particularly advises avoid-
ance of the red end of the spectrum because of
the "pronounced chemical changes" which the col-
ors of that end produce in the eyes, and Landon
particularly advises the selection of green, as it
stimulates "capacity for work and care in the
execution of it" and maintains "the vitality of the
subject." It may be that Landon's conclusions
are somewhat fanciful, even though they are
drawn from a very carefully planned and exe-
cuted series of experiments, or perhaps we under-
value the less obvious conclusions because the ob-
vious ones are matters of such common knowl-
edge, such as the depressing eff'ect of dark rooms
and the contrary effect of well-lighted ones, but
his major conclusions agree wholly with those of
the other two authors, who are both ophthalmolo-
gists and intei'ested in securing in schools and
hospitals restful, harmonious color in rooms, be-
cause of the effect on the eyes.
Finally, Cutting^ gives a reason for the selection
of green in its effect upon the pupil. Me shows
that pupillary reactions are in accordance with
luminosity, and green, blue, and violet at the less
luminous end of the spectrum permit pupillary
dilation, so that the eye, looking up from a red
wound and seeing the blue sheets in the imme-
diate environment and the green of the floor and
wainscot beyond them, would have a larger rather
than a smaller pupil when it looked back into the
wound. If, on the other hand, the eye looked up
from a red wound to a white environment, it
would suffer at once a pupillary contraction, for
the white light contains all the luminosity of the
red plus that of all the rest of the spectrum. Look-
ing back now into the red wound, there must be
a time, brief perhaps, but still measurable, when
the eye must reaccommodate itself to the darker
field.
In my original plan, I tried to find a shade of
green that would match the shade of hemoglobin
red, and this resulted in selecting spinach green.
This endeavor to get a brightness or luminosity
in the green equal to that of the red was, of
course, to prevent changes in the pupil. Dr. Cut-
ting's paper, which was presented only in March,
1917, shows that in that I failed, but that the
failure was on the side of helping rather than
hindering the main object of the scheme.
The surface is of importance. Obviously there
must be no glaze on the green tiling or glare
would be possible, and if paint is used in the place
of tiling it must be a flat surface. Above the
six-foot line, however, the surface should reflect
all the light possible, and absorb as little as pos-
sible ; there enamel paints or encaustic tilings are
in order. These details have been carefully ob-
served in the room already constructed.
Finally, all of this is to improve working con-
ditions in the most important repair-shop in the
world — the surgical operating room, where better
workmanship and fewer accidents will always be
needed and demanded.
Completion of First Trolley Hospital Ambulance
The first trolley hospital ambulance for transportation
of wounded men from the seaports to the base hospitals
has recently been completed in Boston. The ambulance
was made fi-om an obsolete open car of the type common
on all surface lines. The backs of the seats were removed
SRapp, Alfred C. : Surfaces and Colors for Hospitals and Schools,
with Discjission by Dr. S. D. Risley, Prefatory Notes by Dr. S. D. Ris-
ley and Dr. Edward B. Heckel, Bull. 38, Educational Bureau. Paint
Manufacturers' Association of the United States.
•iCuttinB, James A. : The Reaction of the Pupil to Colored Light,
Jour. Nerv. and Ment. Dis., October, 1917, XLVH, No. 4.
Copyright Underwood & Underwood, New York.
SO that the car will accommodate sixteen hospital litters
and sixteen patients who are able to sit up. John Lindell,
superintendent of the Boston Elevated Railroad, designed
the car at the suggestion of Brig.-Gen. John A. Johnston
and with the assistance of Colonel Staub.
THE MODERN HOSPITAL
99
THE STATE SAINATORIUM AND THE LABOR PROBLEM
Employment of Prison Labor- Converting the Sanatorium Farm From a Liability Into
an Asset — Meeting Agricultural Standards of State Board
Bv STEPHEN A. DOUGLASS, M.D., Ohio State Sanatorium, Mount Vernon, Ohio.
I HAVE been prompted to write the following
because of several inquiries which I have re-
ceived relative to the adoption of prison labor,
the so-called "honor system," to solve some of the
difficulties of the sanatorium labor problem.
The situation at this time is so acute, owing in
a large measure to the exigencies of war and the
consequent high price of labor, that the average
institution, particularly the isolated rural insti-
tution with farm lands, finds it next to impossible
to secure competent labor. This is a constant
"thorn in the
flesh" to the
medical superin-
tendent who is
interested and is
held responsible
for the character
of the profes-
sional work of
the medical and
nursing staffs, for
the maintenance
of d i s c i p line
throughout the
institution, and
for the super-
vision of all sani-
tary conditions,
such as the prep-
aration and serv-
ing of food, the
disposal of waste,
the sterilization of infected materials, the clean-
liness and fumigation of buildings, and the
requisition and inspection of supplies, in addition
to making a sustained effort to instruct and en-
courage his . patients. He perhaps resents the
fact that he should be held responsible for the
organization and result of farm work, for which,
by training and inclination, he is not particularly
adapted.
The sanatorium, situated on any considerable
tract of land and depending on paid labor, has on
its hands today the proverbial "white elephant."
A number of institutions in the Mississippi valley
are so afflicted. Many state sanatoriums inher-
ited what has proved to be the handicap of "broad
acres," because building commissions had formed
the habit of purchasing large tracts of land for
their penal and insane institutions and no distinc-
herd of registered Guernseys which provide
tori
tion was made for the institution where rest was
a cardinal and fundamental principle of treat-
ment.
This is not a dissertation or discourse on the
application of graduated exercise. Only one ob-
servation is made: when a tuberculous patient is
ready for farm work, or a full day of any real
work, he is ready to be discharged from the sana-
torium as a patient.
This institution, eight years ago, acquired 350
acres of abandoned farm land; 180 acres wood-
land and campus,
the remainder
suitable, when
cleared, drained,
and fenced for
farm and pasture
lands.
The first year
some land was
cleared and roads
and fences were
constructed in
addition to some
farm and garden
operation. Three
men were em-
ployed, but farm
receipts, notwith-
standing our ef-
forts, did not bal-
ance salaries and
mainte nance.
In the fall of 1911, a central board. The Ohio
Board of Administration, acquired control of all
our state institutions. A program of general and
intensive farm operation was adopted, that is,
general farming, orcharding, gardening, dairy-
ing, and poultry and hog raising. An agricultur-
ist, a horticulturist, and a veterinarian were
attached to the board, who formulated and laid
down uniform standards of farm organization
and operation, and whose duty it was to oversee
and enforce these measures. This scheme had
practical application to the large penal, correc-
tional, and insane institutions which had labor
galore, but to us the proposed program, as applied
to our organization, appeared not only formidable
but rather ludicrous. Our "personal service" ap-
propriation would not permit of such activity,
and, if attempted, our ratio of employees to pa-
of the Ohio State Sanatorium, Mount Vernon, showing in the foreground the
adequate milk supply for the
100
THE MODERN HOSPITAL
tients would become top-heavy, giving an excel-
lent opportunity for criticism from those who be-
lieve in the "open season" for all institutions.
Moreover, we knew of no similar institution car-
rying on such a program as evidenced by the
annual reports of their farm operations. A re-
cent superintendent's report on farm operations
in a neighboring state sanatorium tersely states,
"The farm shows a deficit of $1,200."
With this formidable program staring us in
the face, we appealed to the newly constituted
board, explaining our difficulty and our limita-
tions. The only solution apparent was the trans-
fer of prison labor. In March of 1912 an "honor
squad" of ten men from the penitentiary was
transferred to the State Sanatorium. This was
the initial transfer. The system has been applied
subsequently to a number of institutions in Ohio.
to its average strength by transfers from the state
reformatory.
These men are young "first off'enders" having
an indeterminate .sentence. In our judgment, they
are more efficient than the usual penitentiary
transfer. We have never had any trouble among
the employees or patients from the arrangement.
Only a very small percentage have had to be re-
turned because of infraction of rules, ineflSciency,
or insubordination. Three during the six years
have taken "French leave." It is necessary, of
course, that the warden exercise good judgment
in selection. If care is taken, transfers for in-
fraction of rules, etc., are minimized.
We have utilized this labor for other than
actual farm work as follows : one man served in
the laundry for a period of five years and after
being pardoned became chief laundryman ; an-
P'ie- 2. The greenho
Ohio State Sanatori
Dormitory accommodations were available in
a wing of the power house ; meals were provided
at a separate table in the employees' dining room.
These men, with the exception of one who was
assigned to the laundry and one assigned to the
chief engineer as plumber and electrician, were
placed under the charge of the farm foreman and
garden foreman. Two distinct departments were
created, namely, farm and garden, the farm fore-
man being respon.sible for his "division of live
stock," dairy, piggery, and poultry yard in addi-
tion to the farm and orchard. The garden fore-
man was responsible for the garden, greenhouse,
small fruits, lawns, shade trees, shrubbery, and
flower beds. We have had an average of eight to
ten men from that time. Many have been par-
doned and paroled. While stationed here, several
have completed their sentence. During the last
eighteen months we have been keeping the squad
constructed entirely by prison labor during the winter months,
other served as plumber and electrician for five
years ; another served in the dairy for four years ;
another was employed as carpenter for two years.
The service of this group at $30 a month would
exceed $6,000 for the period. Three of the group
cited above were pardoned by the governor. Oth-
ers have been employed as dishwashers, kitchen
assistants, and lawn men for shorter periods.
In the winter of 1915, we utilized this labor en-
tirely in constructing a greenhouse.
The arrangement has enabled us to clear, fence,
and drain our farm and garden lands and to cul-
tivate them efficiently ; to develop a herd of regis-
tered Guernseys, which insures an adequate milk
supply ; to set out and cultivate an orchard and
vineyard ; to operate a greenhouse, which supplies
us with fresh vegetables and flowers during tlie
winter months ; to maintain a piggery and poultry
plant at a profit, and to care for our campus and
THE MODERN HOSPITAL
101
grounds. Transportation of supplies from the
station three miles away is handled without diffi-
culty.
The selection of the foremen is important. The
qualifications of these men should be investigated
carefully and sufficient salaries should be paid to
acquire and hold suitable talent. One man can
control and develop among this class of labor an
esprit de corps which will make them efficient
and trustworthy ; another fails signally. We had
one man who failed because he assigned and
divided his work instead of "bunching" his men
and setting the pace for them. In other words,
he attempted to become a supervisor instead of a
working foreman, and the system broke down.
Under this system the sanatorium farm has
finally become an asset. Receipts have shown a
gradual annual increase, and we believe we are
making a creditable showing. Our acreage pro-
duction compares favorably with that of any
other institution. Increased farm and garden re-
ceipts have, to a considerable degree, enabled us
to keep pace with the "H. C. L." and to keep
within reasonable bounds the ever-increasing
tendency of the per capita cost. Receipts over
cost of production for the year amounted to
$8,000. Prices of produce were based on a uni-
form schedule prepared by the board, which is 8
to 10 pei'cent under prevailing prices.
Labor credit, other than actual farm work, bal-
anced salaries and wages. All expenses against
the farm and garden, including maintenance of
these men, interest on investment, depreciation in
equipment, etc., have been carefully computed
and charged. The farm and garden show a net
35 percent profit on the gross receipts based on
the accounting system, as set forth in Bulletin
511, U. S. Department of Agriculture.
The system allows more liberty, better environ-
ment, better diet, and a happier, healthier, exist-
ence for these men. We believe the system war-
rants adoption by all state sanatoriums with the
"broad acre" impediment, for in no other way
could we have made a semblance of a showing or
have had a solution of the problem, nor could we
have escaped criticisms for our failure to fulfill
the "agricultural standards" of our board.
A French girl of sixteen wrote to a war worker in
Washington : "There is a river in France so narrow that
you can talk across it, birds can fly across with one
sweep of their wings. There are great armies on either
bank. They are as far apart as stars in the sky — as right
and wrong. There is a great ocean — it is so wide that the
seagulls cannot fly across without resting. Upon either
shore there are great nations. They are so close together,
however, that their hearts touch."
AN AMERICAN RED CROSS HOSPITAL IN LONDON
Inviting and Luxurious Appointments of Latest Hospital
for .Vmcrican Officers
The American Red Cross Hospital No. 24, which was
recently opened at 24 Kensington Palace Gardens, W.,
may be summed up in one word — "perfection," according
to a writer in the British Journal of Nursing. The house,
its equipment, and running expenses are the munificent
gift of Mr. Chester Beatty. It was offered to the Ameri-
can Red Cross Society for the use of American officers,
should the authorities decide to bring them to England
instead of nursing them in France, as it is at present
proposed. In the meantime, British and Colonial ofl!icers
are to be received. It has thirty-five beds and is staffed
by the American Red Cross, under the commanding officer,
Captain Chollett. The Nursing Staff consists of a matron,
four sisters, and V. A. D. probationers. The matron.
Miss Minnette J. Hay, was trained at the Roosevelt Hos-
pital, New York.
On the ground floor of the hospital are the library and
lounge, both ideal for their purpose. The lounge is up-
holstered in soft green and has a plentitude of luxurious
easy chairs. It opens into the fine conservatory, from
whence the patients can be wheeled into the quiet, high-
walled garden.
Every ward is charming, with its white enameled fur-
niture and white pique quilts, the silken eiderdowns and
curtains giving various color tones in the different wards.
Some are .soft rose color, some blue, and some old gold.
The buff screens which prevail in most of the wards are
particularly restful. The white bed tables and enamel
lockers with glass tops are the last word in appearance
and utility.
The luxuriously appointed bathrooms, of which there
are a large number, will be a joy both to the patients and
their nurses. Indeed, it would be difficult to suggest any-
thing for use or ornament that has not found its place
in this ideal refuge, which is ready and waiting to receive
the sorely pressed, weary, and wounded officers who are
making such a magnificent stand at the front. Nothing
has been spared that will minister to their healing and
recovery.
Industrial War Gardens
The Inspiration Consolidated Copper Company, of Ari-
zona, has given an excellent example to other great corpo-
rations in fostering the Victory garden among its em-
ployees.
"At present there are over 500 war gardens planted
in this district, and by the end of the month there will be
800," writes J. R. Sandige, agi-icultural expert with the
company in Gila County.
The Inspiration Company cleared, fenced, harrowed,
ditched, and leveled 75 acres of soil, divided it into eight-
acre tracts, and furnished the seed and water to any em-
ployees who would undertake to raise the crops. All the
gardener is expected to furnish is hoe and "pep." In-
structions are furnished by Mr. Sandige and his assistants.
A Victory garden market has been established in con-
nection with this work, and this year a community can-
ning and drying plant will be installed, with the water
and fuel furnished free. What this company is doing
other corporations could do, and there is still time to act.
There are two things I never worry about — those things
I can't help and those I can. — Robley D. Evans.
102
THE MODERN HOSPITAL
HOSPITAL ACCOUNTING
Complete System of Bookkeeping for Either Lar^e or Small Hospitals and Allied Insti-
tutions—Methods for Purchasing, Receiving, Storing, and Distributing Sup-
plies—Forms for Record Cards, Blanks, and Books to Be Lsed
for the Systematic Management of the Hospital— Practical
Budget System Presented
By CHARLES A. PORTER and HERBERT K. CARTER, of the Staff of The Modern Hospital.
other records, and the manner in which they are
INTRODUCTION
THE authoi-s of this series of articles fully ap-
preciate the difficulty of devising a system of
accounting that will meet the requirements of all
hospitals. Local conditions in different hospitals,
regardless of the sizes of the institutions, will
always vary. A one-hundred-bed hospital located
in New York may have an entirely different or-
ganization from one of the same size in another
city or one of the same size in the same city. In
fact, it is seldom that any two hospital organiza-
tions will be found that are alike in every respect.
It is this difference in organization which makes
it impossible to devise a method of accounting
suitable for all hospitals.
On the other hand, the same underlying princi-
ples govern the accounts of all hospitals — the
theory of debit and credit is the same the world
over. This fact has given us hope that these
articles will be a help to the hospital adminis-
trators.
All hospitals should have a complete accounting
system, with internal checks, that will show all
revenue and expenditure, and give comparative
statistical data that will be valuable to the man-
agement from year to year and to those interested
in hospital work throughout the country.
The methods described were formulated after
a thorough study of the accounting systems used
in many of our leading institutions, and designed
to meet their needs with regard to detailed infor-
mation for the Superintendent and other hospital
executives. We do not claim that every institu-
tion can advantageously install the system as out-
lined without changes and modifications to meet
particular needs.
In presenting these articles we assume that
those in charge of the records pertaining to the
business transactions of a hospital are experi-
enced in accounting practice, and will be able to
distinguish between those methods which they can
adapt to their owoi use and those which they can-
not use to advantage.
We have gone further than the bare theory of
accounting as set forth by the text-books on the
subject, and have outlined a purchase order sys-
tem, showing forms of orders, price cards, and
to be handled. A receiving and storage system,
showing how the supplies should be kept, dis-
tributed, inventoried, and their controlling ac-
counts kept in the general books, is given in detail.
We have also shown how a departmental expense
analysis should be made up and how the budget
should be prepared for presentation to the Board
of Managers.
It is by analyzing expenses that we are enabled
to inaugurate savings. Comparisons are the
friend of the Superintendent, because, by showing
where curtailments may be made, they enable him
to get the best results with the money at his dis-
posal. An important point to be remembered is
that the best method of showing the variations in
the financial standing of an institution is by means
of a properly designed chart.
Simple forms of single and double entry book-
keeping will be given, with the rules which govern
all bookkeeping.
The various forms mentioned by number in the
text will be found printed in the installment hav-
ing reference to certain forms, and the reader, by
studying these forms in connection with the text,
will obtain a more comprehensive idea of the sys-
tem outlined.
We wish to thank those hospital executives who
have so kindly assisted us in the preparation of
this matter, both for the courtesy they have shown
us and the valuable suggestions that they have
made.
Charles A. Porter.
Herbert K. Carter.
ACCOUNTING SYSTEM
purchasing
One person known as the Purchasing Agent,
though he may have other duties, should have
charge of purchasing all supplies, materials, and
equipment for the hospital. The Storekeeper and
Receiving Clerk, whether the two positions are
held by one man or more, should make reports to
this person of the receipts of purchased commodi-
ties.
The records of the Purchasing Agent are dupli-
cates of orders, price cards, contracts for the pur-
THE MODERN HOSPITAL
103
chase of some groups of supplies, records of the
standardization of supplies, and requisitions de-
manding the purchase of equipment and miscel-
laneous supplies for the various departments of
the hospital which are not kept in the general
stores or drug rooms. The last-mentioned rec-
Article
Price CAao
5lZE
Ol/ZILITY
DcscaiPTiov 1
1
Vemoer
1
-«-&>
-^--C^r >
L_!--J
L^_^-
U'-^=
L^"^
Form 1. Price Card. Actual .";ize, 6 by 4 inches.
Qt/OTATIOrti
Quoted By
ords (requisitions) would be for such articles as
water stills, sterilizers, operating tables, special
food products for pay patients, apparatus, and
equipment. It seems w-ell to note here what are
supplies, material, and equipment:
Supplies are those articles, purchased for con-
sumption or maintenance, which cannot be
charged to the equipment or material accounts.
Form 2. Detail Price Card. Actual size, 10 by 8 inches.
—
PURCHASES
„. '^
XT
^^.
tF:
] ■...„.
,,.4....;.„-
>., v.„
.. S^J.,!
- ■■ , 1 , ^ 1 1
—
1
1
'-^_^. L:
i;
i=i
ir
bi^
y|_
Z^i=
-_L±J.
=y
Form 2.\. Reverse side of Detail Price Card.
Materials are those things purchased which are
sold in their original foiTn or are transformed
and sold, such as cloth, iron, etc., used in making
braces for cripples, crutches, abdominal support-
ers, and elastic stockings.
Equipment embraces furnishings, apparatus,
instruments, etc., necessary for the operation of
a hospital; as a rule, to remain in use for more
than one year.
A form of purchase order (Form 3) is shown,
which is made out in triplicate ; the original order
going to the vender, the duplicate being placed in
the Purchasing Agent's files, and the triplicate
going to the Receiving Clerk. The Receiving
Clerk is thus notified as to what goods he is to
expect and from whom. This triplicate should
not show quantities of goods ordered, the Receiv-
ing Clerk being required to make an actual count
of all goods received.
The MODERN HOSPITAL
PLEASE SHIP FOLLOWING
Form 3. Purchase Order. Actual size, 8V4 by 11 inches. Bound in
triplicate (original, white; duplicate, pink; triplicate, buflfl, and
numbered consecutively.
The use of price cards (Forms 1, lA, 2, 2A) is
recommended. They should give a complete de-
scription of all of the ordinary supplies used in
the institution. This information includes price,
quality, size, brand, etc., the names of firms mak-
ing quotations, and the dates of the quotations.
ORDER
REQUISITIOti
.V-
7..
«^'"'-""
„«„.,-<."""-»-<-."
«./"
T.T.L-.-f.--"
II se
jc=i»T.ot. ;».';, 1
of«.'ic v-»OI«~
' ' '
1 ' i '
^^
——^-^ i--^ L
— ~— >
Form 4. Order Requisiti<
8^4 by 8 inches.
Contracts may be made either on standard
forms or by letter. They should be made for coal,
showing size, peixentage of ash, British thermal
unit-- per pound, and other details — prices, terms,
and deliveries ; for milk and cream, showing per-
centage of butter fat required in each grade and
104
THE MODERN HOSPITAL
allowable bacteria per cubic centimeter, with
prices and the period of the contract. It is also
well to obtain quotations and make monthly con-
tracts for butter, eggs, meat, fish, and poultry.
When it is advantageous to do so, canned goods
should be purchased by contracts covering a
period of one year.
Requisitions (Form 4) for the purchase of
equipment and articles not entered on the store
records should form a part of the Purchasing
Agent's records. These must give a complete de-
scription of the article wanted, the name of the
department requisitioning the same, the signature
of the head of the department, and be approved
by the Superintendent of the hospital.
RECEIVING
The location of the Receiving Department and
hours during which goods are received should be
printed on all purchase order forms, as is shown
on Form 3.
The duties of the Receiving Clerk, who may
also be the Storekeeper and possibly the Steward,
is to examine all articles as they arrive, note the
condition of the goods, make a careful list of the
quantities on his copy of purchase orders, and
sign the receipt books of the delivery men. It is
also his duty to see that all supplies and equip-
ment are delivered to the departments ordering
them.
CHECKING ORDERS
After the Receiving Clerk has received all of
the goods on a given order it should be sent back
to the Purchasing Agent to check the quantities
against the original order and the invoice prices
against the price cards. The invoice is then sent
to the Accounting Department.
The store room should be in charge of a person
who is held responsible for all the material and
Stock Card. Both sides are ruled
size, 8 by 6 inches.
nd printed alike. Actual
supplies contained therein. The room should be
kept under lock and key, and no goods issued
except on requisition. The Storekeeper's stock
cards (Form 5) give a complete record of goods
received, issued, and the balance on hand at any
given time. When properly kept, these cards con-
stitute a perpetual inventory. The cards should
show the maximum and minimum quantities ad-
visable to carry in stock and the quantity to order
of the various articles carried in stock ; also the
location of the articles in the store room. When
goods fall below the minimum, this is automat-
ically shown on the stock cards. A shortage re-
Weekly Shortage Repc
Ceinehal Jtorej 01 Drug Roo
r
DE.cmPTION
»,„,„„M
«,Mn..M ^5^;.,
"?r
l_-~^— - — ^ --^ 1
L — .J
L' — ^-J
L y
Korm 6. Weekly Shortage Report. Actual size. 8>i by 13 inches.
port (Form 6) should then be made out, showing
the goods needed and the amount to be purchased.
The stock room should be arranged according to
the requirements of the articles carried in stock.
Goods which could be affected by vermin should
not be placed against the wall. Bulky articles
should be so placed as not to interfere with the
accessibility of other goods. Sections should be
assigned to various groups of articles. Canned
goods, cereals, flour, sugar, etc., should be under
separate groups.
DRUG ROOM
Owing to the manner of issuing drugs from
stock, it would be impracticable to keep a stock
record in this department. The weekly shortage
report (Form 6) may, however, be filled out and
sent to the office of the Purchasing Agent, as in
the case of the general store. Here, as in the gen-
eral store room, supplies are usually charged to
professional care of patients or to the dispensary
or other departments on the Charge Register and
no account of them kept in the General Ledger.
This does not give correct results from month to
month, but the aggregate at the end of the year
will be near enough for ordinary purposes. The
reason this is not actually correct for monthly
costs is because many expensive drugs may be
purchased during one month and cheaper ones
purchased the next.
The ordinary method of finding the cost of
compounding prescriptions is to divide the total
cost of the department by the total number of
prescriptions compounded, which gives a unit
cost.
INDEXING THE DRUG STOCK
The drugs in the drug room of the large hos-
pital may be listed according to their classification
in the pharmacopeia, but in the smaller hospitals
where a druggist is not continuously employed
this index should be kept alphabetically and the
drugs listed regardless of their classification, in
order that a person entirely ignorant of drugs will
THE MODERN HOSPITAL
105
DIvSTRIBUTIOn OF 5T0RE5
Month £ndtnq_
/^/_
Date
<iUPPLItS CHARGED ACAinSX DEPART
Bttti) 1
AtMlHliT
syevtm
«i.l
M*TffOf.i
L-'U^DRvl
OffUft ll#«M
0fji>£nj4M|
r-cc™
4W«i/^«nt:c
A-flAV
i>i*w«ro*v
/*I.r J»
.««.»<,
tTAKOS
'iz-J.-
i
^
Z
■J
__
[
1
LI
L^
L — 1
—-^
! —
L^
^
30
- -
_r=:z
==^-
— :=
-
p=p
^X—-
—
3>
-
-
Form T. Distribution of Stores. Actual size of ruled paec. 14% by 12 inches. Bound book, with binding margin to be added at left-hand side.
SUPPLY REQUISITION
fio.
Dp.puriment
9U/ir»T(TY
p"'c\
V^LUB 1
<jn Hflno wAmeo
liSUEO
1
1
1
■ --L_^_
-
< -~J
^ -— ^^ ~~ ^
r — ~~i
^
1 — -^
/ htrcbtf ce.r<ffu -theH: -fht aijove- arf$ct€S art needed bi/ -fAe
dejbarfment
^Stance/ Dep't Head
fivprored Si/jo r.
.-ictu.-il size. 6V2 by 10 inches.
Mo.
DRUG REQUISITION
Da *e />>/_
5i/
Ap/?rorecJ_
Jr/b't- of nurits
Oefii_
MOOERM HOSPITAL
/yo.
Requisition for Repairs
-
Dele—-
191
Location
REPAIRS REQUESTED
Approved
nJ (usigneJ to
Ax
■/ Sup 7
^
1 cahfn Ih
t the ohovf repairs have hee
maJe
Dep
■( HcoJ
^
N B Mtc
ttuta the order lo the office of
on tiza^ br Hc^d
Cie Superintendent,
of DepmrtmeDt r
.......
Form 9. Drug Requisition. .-Actual size, 4 by 7 inches.
Form 10. Repaire Reiiuisition. .Actual size, 5 by 9 inches.
be enabled to locate those desired without undue
trouble.
In the large hospitals having all the clerical help
needed a complete card record of prices should
be kept, showing cost per pound, ounce, brand,
cubic centimeter, or in grains, so that a monthly-
report showing the number and cost of all pre-
scriptions compounded for each department can
be m^ide out.
REQUISITIONS
Supplies should be issued only on requisitions.
All requisitions should be made out by the head of
106
THE MODERN HOSPITAL
the department, and approved by the Superin-
tendent, except in the case of the Steward's sup-
plies. Requisitions from the Steward should go
direct to the Storekeeper.
Four forms of requisitions are shown — namely,
order requisition (Form 4), supply requisition
(Form 8), drug requisition (Form 9), repairs
requisition (Form 10).
A requisition containing a printed list of the
main articles required by the Steward and House-
keeper is sometimes used in large hospitals.
DISTRIBUTION OF STORE SHEET
The correct manner in which to handle charges
for supplies is by means of the store distribu-
tion sheet (Form 7). All requisitions for sup-
plies are totaled daily for each department, and
the amount entered on the sheet under the de-
partment heading. At the end of the month the
columns are totaled and charges made to the
various departments on the general books. This
necessitates an account captioned "Supplies," and
is handled through the Charge Register just the
same as the material account.
This method enables the hospitals to charge off
supplies as used instead of as purchased, which is
common custom.
The value of supplies as shown by the general
books should equal the value shown by the stock
cards.
INSTRUCTIONS FOR ORDERING SUPPLIES
1. Do not tear out the original copy.
2. Do not write in the column headed "Issued."
3. Do not crowd orders for more than one
article or form on one line of the sheet, but use
a second sheet if necessary.
4. Do not fail to insert quantity on hand in
proper column.
5. The column headed "Issued" will show just
what has been supplied on the requisition, and
when the space has been left blank it means goods
ordered will follow as soon as possible.
6. Give as good a description as possible, espe-
cially as to size or number.
7. Articles of equipment will not be furnished
or replaced until others have been condemned in
the usual course.
8. When condemned goods are returned to the
store room, a li.st must accompany them and be
marked "Condemned Goods."
9. Order all blank forms by number, and not
by the description or heading. All forms are
numbered
10. On receipt of goods, quantities should be
checked and Storekeeper notified at once of errors.
11. Requisitions should be limited to a supply
sufficient for one week.
12. The storekeeper will not issue goods with-
out a signed requisition approved by the Super-
intendent.
DOUBLE ENTRY BOOKKEEPING
Owing to the complex transactions involved in
the business of hospitals and allied institutions,
double entry bookkeeping is the best method of
recording them. The three principal reasons for
this are: first, because of the element of time
which enters into the transactions; second, be-
cause there are internal and external checks
which guard against error and help to prevent
fraud; and third, to obtain proper statements of
the operating cost and standing of the organiza-
tion in minute detail for comparative and statisti-
cal purposes.
These statements can best be obtained from a
double entry system, which shows a complete rec-
ord of every transaction on both the debit and
credit sides of the various accounts. An account
is kept with every element of the business, such
as personal accounts, supplies, capital, real estate,
cash, loans, mortgages, etc.
In hospital accounting it will be necessary to
keep the following books : Journal, Cash Book,
Charge Register, Pay Roll, Check Book, Pay Pa-
tients' Ledger, and General Ledger.
For statistical information, other books and re-
ports, to be described later, are kept.
The Journal takes care of all entries which
cannot be properly entered in the Cash Book or
Charge Register. These entries usually require
a brief description.
The Cash Book takes care of all transactions
involving cash, and the Charge Register of all
bills payable.
The Charge Register becomes the foundation of
statistical information, as it shows the distribu-
tion of all expenditures. A notation is made in
this book when bills are paid, which furnishes a
means of obtaining a list of creditors.
The total of bills payable of previous months as
shown by the ledger, plus the total of debts in-
curred for the month, less those paid, gives the
amount of bills remaining unpaid at the end of
the month.
A comparatively new kind of Cash Expendi-
tures Book called the Combination Cash and
Check Book (Form 19, which will be shown in the
next installment) is recommended. This takes
the place of the Cash Expenditures Book and the
Check Book. This method of handling disburse-
ments is being adopted by many institutions and
saves considerable time. It gives an exact dupli-
THE MODERN HOSPITAL
107
cate of all checks and reduces the possibility of
fraud or error by eliminating the necessity of
copying.
Ledger accounts are opened with people, prop-
erty, funds, stocks, bonds, mortgages, loans, cash,
material, supplies, interest, bills receivable, bills
payable, equipment, real estate, and others as
may be necessary.
The accuracy of all these accounts is tested by
listing all of the debits and credits of the General
Ledger, totaling them and then noting whether
the totals agree. If it should happen that these
two totals do not agree, it is positive evidence that
there is an internal error or that some fraud has
been perpetrated.
All entries in books of original entry are posted
direct to their respective accounts in the General
Ledger.
A few of the general rules of double entry book-
keeping are given below:
1. For every^ debit there must be an equal
credit.
2. Debit all receipts.
3. Debit that which costs value.
4. Credit all disbursements.
5. Credit that which produces value.
6. Debit interest for its costs.
7. Credit interest for its returns.
In many institutions all of the books are kept in
one office by one accountant. In an institution of
this kind the following books will be necessary :
1. Journal.
2. Charge Register.
3. Accounts Receivable Ledger.
4. Pay Roll.
5. Stock Cards or Ledger.
6. Cash Receipts.
7. Cash Expenditures.
8. General Ledger.
9. Trial Balance.
In most hospitals it is necessary to keep a set
of books known as the Superintendent's and an-
other known as the Treasurer's. In this case the
Superintendent's books are:
1. Journal.
2. Charge Register.
3. Pay Patients' Ledger.
4. Cash Receipts.
5. Cash Expenditures.
6. Stock Record.
7. Pay Roll.
8. General Ledger.
9. Trial Balance.
The Treasurer's books are:
1. Journal.
2. Cash Book.
3. Income Ledger.
4. Endowed Bed Ledger.
5. General Ledger.
6. Loans Book.
7. Trial Balance.
Into these the Treasurer incorporates the re-
port of the Superintendent to him and the fund
and capital entries to be found in his own books
of original entry.
[To be continued.]
CENTRALIZED PURCHASING AS AN AID TO HOS-
PITAL ECONOMY
Cleveland Hospital Council Establishes a Purchasing
Bureau, Affiliated With New York Bureau
The purchasing bureau of the Cleveland Hospital Coun-
cil began operation on June 15. Mr. Guy J. Clark, former
assistant purchasing agent for the city of Cleveland, has
been employed as purchasing agent, for the council.
Centralized purchasing has been under consideration
by the Cleveland Hospital Council for over a year. In
the spring of 1918 the executive committee recommended
that the council organize a purchasing bureau; that
the council affiliate with the New York Bureau of
Standards and Supplies; and that the Welfare Federation
be requested to assume responsibility for the raising of
funds required for this department.
In discussing the proposition that the council organize
a purchasing bureau, the committee on purchasing and
standards said:
"The twenty hospitals now represented in the council
do their own individual purchasing of provisions, general
supplies, medical and surgical supplies, etc., amounting to
approximately a million dollars a year. A central bureau,
properly organized, would be of real service to the hos-
pitals in this work. While it is difficult to estimate sav-
ings in advance and at all times difficult to determine the
results of centi'alized purchasing in dollars and cents, un-
doubtedly considerable saving could be effected in the
joint anticipation of wants and the purchasing of bulk and
standard articles. It could be helpful in the formulation
of contracts and putting hospitals in touch with the
proper places to buy commodities. It should be a bureau
of information to be consulted by the hospitals at any
time on all matters involving purchasing and standards.
Experience in modern business has proved conclusively
that centralized purchasing is worth while. There is no
reason why such business principles cannot be effectively
adapted to hospital management throughout a common
purchasing bureau. The hospital council and its constitu-
ent members are ready for such a bureau. The services
of the bureau might soon be available to the various chil-
dren's institutions, all of which purchase supplies such
as are used by hospitals. In time, the principles of cen-
tralized purchasing as applied to these institutions might
be extended to all of the various welfare institutions in the
city."
The Chemical Corps
They get no song to boost 'em along, they get no words of
cheer ;
For what they do is a job so new some of us don't know
they're here;
But they work away in the lab all day to help us win the
war;
Let's not forget we owe a debt to the men of the Chemical
('orps.
For it's HCl to give 'em hell, and H2SO4.
C2O3 and TNT — the men of the Chemical Corps!
— F. P. A., Stars and Stripes.
108
THE MODERN HOSPITAL
LITTLE JOURNEYS TO PLACES AND PEOPLE WORTH KNOWING
The Third Little Journey— To St. Anthony's Hospital at Carroll, Iowa— A Hospital Which
Has Much Picturesque Beauty of Surroundings and a Great Community
Value for a Lar^e Rural Population
By MARGARET J. ROBINSON, R.N., Field Editor of The Modern Hospital, Chicago.
hood that owns it, whose mother-house is at La
THE town of Carroll, Iowa, is small and not
particularly inviting at first glance. There
is, of course, a railroad station. There has to be
a place for the train to stop, and a waiting room,
and somewhere to check baggage, and some place
to house the spittoons and the penny-in-the-slot
machines from which you can get a minute por-
tion of chocolate or chewing gum when they are
in working order. Then there is a main street;
there are some stores and a courthouse, a moving
picture show, a restaurant, and quite a lot of
houses, and last but far from the least, a hospital.
I must confess that my hopes did not rise very
Crosse, Wis., bears the quaint and stately name
of "Franciscan Sisters of Perpetual Adoration."
The community owns forty acres of land and
has its church and grade schools, a high school, a
new building for the school of domestic science,
farm lands and outbuildings, and the Hospital of
St. Anthony.
St. Anthony's crowns a hill and overlooks a
clear stretch of winding creek and rolling hills
beyond. On the left were plowed fields and orch-
ards. You have to go around the half circle of
the building to reach the front door. The archi-
high as to what that hospital might be like when
I found it, but I certainly had a most agreeable
disappointment in this particular case. Carroll
at first gave nothing to show that in this little
county seat was to be found one of the best hos-
pitals in the state — a hospital filling a great com-
munity need, and one that has picturesque beauty
and a very human atmosphere about it. Which
all goes to show that sometimes we find the big-
gest and finest things in little places, and that the
greater credit is due to those who make progress
where progress is most needed and sometimes the
least expected.
The community of which St. Anthony's is a
part is about a mile outside of the town, and up-
hill toward the last of your journey. The sister-
is of the Perpetual Adoratii
tect was wise enough to face the hospital toward
the hills and the creek in the valley instead of
toward the road leading to the town. Entering
the hospital, I was greeted as an expected guest,
for some time previously I had met two of the
sisterhood in Des Moines and told them that I was
coming to Carroll later.
Sister Antoinette, the superior, came to show
me the courtesy of the house. Sister Antoinette
and all the other sisters are proud of St. An-
thony's, and well they may be proud of this de-
lightful place of rest and comfort for the sick,
where one can get food from the garden and the
cows and the chickens straight to one's bedside
tray, find means for scientific diagnosis, and get
good ijursing care and a human interest in the
THE MODERN HOSPITAL
109
individual. What more could any poor sick man
or woman ask from a hospital than this?
The superior and the sisters in charge are en-
thusiastic hospital woi-kers. They are not con-
tent with any equipment or methods they have
used if they can learn of any better. They are
planning to build an isolation hospital for infec-
tious diseases and a twenty-five-thousand-dollar
building for a nurses' home on the campus. The
plans for this home will include a basement which
is to be used entirely for a gymnasium and indoor
sport. The first floor will have parlors and din-
I don't wonder that they want visitors to go
to that roof. The clear and unobstructed view
of God's country you get from up there is an in-
spiration. There is nothing between you and the
sides of the sky but rolling land and creek and
cultivated farms as far as your eyes can see. It
would be worth climbing the stairs to see if the
elevator were out of order.
The sister superior waved her hand to the right
and left and said, "You see we have here almost
evezything we need to eat. We raise it ourselves,
and, in the summer, the fresh things we do not
^
ew of St. Anthony's Hospital.
ing rooms and offices which will be used for a
graduate nurses' registry.
This graduate registry will be a unique thing
for a rural district. Any graduate, whether of
this school or any other, may register here and
have her room and make this nurses' home her
home. Each nurse, whether graduate or pupil
in training, will have a room to herself, and each
of these rooms will have a lavatory with running
hct and cold water.
After telling me of the plans for new things.
Sister Antoinette said to me, "I am going to take
you to the roof and show you the view from there,
and then we can come down and see everything
on our way."
eat we put up for the winter. There are our
cows. We have always fresh milk and butter, and
over there are several hundred chickens, and we
have chickens and eggs from our own back yard.
We have two or three farmers to look after it for
us. The high cost of living and running a hos-
pital does not bother us as it does the people in
the cities."
Then we came down to the top floor of the build-
ing. Here, high above the hospital atmosphere,
in a separate wing, are the nurses' quarters, cozy
and comfortable and homelike.
The next floor of the main building has well-
equipped and busy operating rooms and a sepa-
rate wing for the obstetrical department. This
110
THE MODERN HOSPITAL
wing has a maternity room and nursery and pleas-
ant rooms for the obstetrical patients. A gradu-
ate nurse is in charge here.
I asked Sister Antoinette if it was not hard to
get the country people to see the need for hospital
service in maternity cases, and she said, "Oh, yes,
it was at first. I rem.ember one grandmother who
boasted that she had had eleven children and
never even had a doctor with one of them. She
had a daughter who was brought alive through an
abnormal and serious case here and her baby too.
Now the grandmother announces with pride that
no daughter of hers shall stay at home for con-
finement. That is the way it is. When they un-
derstand the protection the hospital can give
them, they are glad to come.
"When I first came here, six years ago," Sister
Antoinette continued, "there v;ere only three or
four patients in the hospital, but now they come
fi'om fifty miles around, and two years ago we
had to build again to make room for them."
On the next floor below are private rooms and
some two-bed rooms. There are no wards. The
country people do not want to go into them, and
the sisters do not believe in them. There are sun-
porches at the end of each corridor, and these are
arranged to take care of out-door cases when this
is necessary. The out-door pa-
tients thrive in the breezes that
come over the hills.
Opening the door of a utility
closet, where the brooms and
mops and pails are kept. Sister
Antoinette showed me the zinc-
lined dust chute, which goes
down through the building. It
can be filled with a suction air
current from below by turning
on a switch at the side of the
chute. Dust and floor refuse are
carried by the current below to
the incinerator, and dry floor
mops shaken out in this chute
have the accumulated dust and
rolls of lint drawn out of them.
Each corridor has its diet
kitchen, and all were spotless.
The trays were not elaborate but
were immaculately clean. The
silver and china shone, and the
tray cloths were of shiny white
hand-ironed damask with a lit-
tle crocheted edge around them.
It is still a mystery to me how
these diet kitchens are kept so
clean. The sisters must have a
magic lamp somewhere, and
when the meals are over they
probably rub it and say "Little
table, disappear," and then all
the dishes wash themselves and
fly to their proper places in the
cupboard.
Down on the first floor, which
is much like the others, is a
special operating room with an unusually good
modern equipment. The artificial lighting of this
room comes from a large central cluster of blue-
globed nitrogen lights. When this is turned on
in the darkened room it fills the room with a clear
artificial daylight that is startling and reminds
one of a stage effect. These lights were especially
planned and designed for this room, and have
given very satisfactory service.
THE MODERN HOSPITAL
111
On the first floor also is the case record room.
One of the graduate sisters is in charge of this
room and is responsible for all of the case records.
These are very complete, including preoperative
diagnosis, physical, pathological, and radio-
graphic findings, history of treatment and oper-
ative procedure and summaries — in fact all the
Fig. 4. A sturdy
farmer who started life at St. Anthony's
things that Dr. Codman says go to make a case
record. The files at St. Anthony's show "what
was the matter with the patient, what the doctor
did for him, and what the result was."
We went down into the basemer^t and saw the
nurses' demonstration room, the sewing rooms,
the living rooms and the rest room for the help,
and the hydrotherapy rooms, and then came to
the radiographic laboratories. There was an up-
to-date machine with all the accessories needed
to do detailed stomach and intestinal work. The
sister in charge is well trained and does thorough
work. She showed us series of bismuth-meal
plates, clearly outlined and developed, and "be-
fore and after" bone plates of cases in which good
arms and legs and hips had been made of bone
injuries which looked in the first plates like indis-
tinguishable messes.
The pathological laboratory is supplied with
every means to detect any bugs that intrude them-
selves into your anatomy. Just outside of the
laboratory there is an animal house for the rats
and guinea-pigs. The salaried pathologist is a
woman physician who has had a long and thor-
ough training in her special work.
"And now," said Sister Antoinette, "we will
show you what we have to eat."
We went down the hall, and taking a bunch of
keys from her girdle, she opened up the store-
rooms. Here, too, thei'e must be a genie of the
lamp. The shelves were full of home-put-up
fruits and vegetables in shining clean glass jars.
I didn't see a tin can anywhere. The food that
comes to the trays at St. Anthony's never gets
any personal acquaintance with railroads or cold
storage plants or packing houses, and I am afraid
that the retail grocers would have little business
if they depended on the kitchens like St. An-
thony's for trade.
As we passed through the main kitchens, one
of the sisters and one of the cooks were fixing
big pans of fresh-picked dandelion greens, and
there was soup cooking on the stove that smelled
like the kind they make at home.
We went next to the cooling room. This is
chilled by a cold-blast fan refrigerating system.
Fig. 5. Getting ready for a bath in the sun.
There wasn't any characteristic ice-box odor
about the place. Dishes of food and trays full of
little pats of fresh butter ready for supper lay
on the shelves, and everything here was spotless,
too.
After showing me the whole of St. Anthony's,
Sister Antoinette took me through the grounds
over to the domestic science building. In the gar-
den we passed a shrine where a meek Christ, a
red lamp burning at his feet, stood in a niche
made of shrubbery just turning gi'een.
In the school of domestic science they are teach-
112
THE MODERN HOSPITAL
ing girls how to cook and to make their own
clothes and to do beautiful laundry work. Down
in one of the demonstration diet-kitchens, sitting
among a friendly group of sisters, we talked of
plans to affiliate the dietetic department with the
hospital, and of how St. Anthony's could give even
better service to its patients and how domestic
science pupils could get better training, when the
special diets for patients in the hospital would
be made in the kitchens of the domestic science
school.
And so ended my visit to St. Anthony's, and
this is the memory I brought away with me.
When Sister Antoinette had showed me the sis-
ters' rest room, where they come for meditation
and prayer, she said, "But we don't get much time
to pray here. We must pray while we work."
And that is the spirit of St. Anthony's.
FROM THE FIELD EDITORS' NOTE BOOKS
A Hospital That Is a Community Educational Center — A Creditable New Hospital
Building — Nerve Conservation in the Training School — A Serviceable
Chart Rack
Cottage Hospital, Creston, Iowa
There are cities of twenty to tliirty thousand population
in Iowa that have not begun to do the public health work
that the little town of Creston, with less than five thou-
sand people in it, is doing for the hundred thousand people
t)f the farming country around it, and when the Cottage
Hospital is completed and in running order, it will com-
pare favorably with the hospitals in the two or three
large cities of the state.
This hospital is equipped with everything to make
scientific diagnosis. It will have a clinical out-patient
Proposed greater community
department and social service. It will be a community
educational health center, and provision is made for pub-
lic health lectures and instruction, Red Cross first-aid
classes and public clinics. The hospital has a complete
record system of its cases, and has files that show com-
plete diagnosis and treatment and the results obtained.
Dr. C. E. Sampson is the moving spirit of the Cottage
Hospital and its public health activities, and the work
in Creston has reached its present success through the
force of his energy and personality and through the pro-
gressive men of his profession who have gathered around
him.
St. Francis Hospital. Waterloo, Iowa
St. Francis Hospital, Waterloo, has a new building of
the best type of steel and cement construction. The in-
terior shows the same type of building materials, and only
the best of flooring, walls, and furniture have been used
in the new buildings.
There is the most modern equipment in the operating
rooms and service rooms and kitchens. As far as building
and equipment is concerned, this hospital will have no
handicap in its efforts to do good work for the city of
Waterloo.
St. Joseph's Hospital, Ottumwa, Iowa
St. Joseph's Hospital in Ottumwa, Iowa, has a rule of
the training school, that after the nurses have eaten their
midday meal, they must sit down for fifteen minutes in
the living room, and listen to the Victrola or read or knit
or whatever else they choose to do. This surely is nerve
conservation, and every nurse goes back to her work
more cheerful and rested than if she had rushed from the
table to her work again.
Chart Rack
The chart rack shown here was described on page 29 of
the July issue. It was designed by the sister superior
of the Sacred Heart Hospital, Fort Madison, Iowa, where
it is in use.
We are not sent into this world to do anything into
which we can not put our hearts. We have certain work
to do for our bread and that is to be done strenuously,
other work to do for our delight and that is to be done
heartily; neither is to be done by halves or shifts, but
with a will; and what is not worth this effort is not to be
done at all. — John Ruskin.
THE MODERN HOSPITAL
113
THE CONDUCT OF HOSPITALS
Who Is to Be Given the First Consideration? The Patient
— Importance of Site, Plans, and Provision I'nr
Comfort and Safetv of Patient
In 1881 the following notice was posted in Minnequa
Hospital: "Who is to be considered first in this hospitall
The Patient."
In the conduct of hospitals the first consideration should
be given the patient. Let it be understood from the be-
ginning that a hospital, whether private, semiprivate, gen-
eral, special, emergency, or war, is for the benefit of the
patients, and not for the convenience of the doctor, intern,
medical student, or nurse.
The second consideration should be given to the site. I
feel that no hospital, except an emergency hospital, should
be located in a city, where it is dusty, dirty, and noisy;
that a hospital should be located where there is plenty of
room for grass, flowers, shade trees, and opportunity for
outdoor life. If a hospital be of benefit to a medical school,
its doctors and students, let the school go to the hospital in-
stead of the reverse; consider patients first.
The third consideration should be given to plans of hos-
pital buildings. If the hospital be located to best advan-
tage, it has been found that buildings of one or two sto-
ries have advantages over those of many stories. Con-
struction is less expensive and, for service given, more
economical to maintain. Plans should call for fireproof
construction and elimination of the elevator, which is
noisy, expensive, and, in case of fire, dangerous. In-
clines graded 1 foot in 6 meet every demand of elevator
or stairs. They accommodate every class of ambulatory
patients — old or young, stout, weak or crippled — are con-
venient for moving wheel chairs, stretchers or beds, and,
in case of fire, safest. In place of elaborate front and en-
trance, expensive board meeting room and showy corri-
dors, let the wards and lower-priced rooms be better fur-
nished and decorated. Cork carpet, varnished, or painted
and varnished, has proved durable, noiseless, not slippery
or cold, and comparatively easily cleaned. If cleanliness
of operating room floor and walls be deemed essential, let
sheet lead be considered for floor and wall covering; it
is durable and withstands the direct application of live
steam.
The fourth consideration should be given to the com-
fort and safety of the patient. Dirt, noise and odors
should be eliminated as far as possible. Sterilization should
be considered, not in connection with an operating room
only, but as well with the culinary department. Prepara-
tions against infection in the operating room are thorough ;
in the kitchen, sadly neglected. More attention should be
given to the cleanliness — sterilization, if you please — of
food, cooking utensils, tableware (knives, forks, spoons,
plates, cups, glasses, etc.), of table linen and dish towels,
of cooks', waitresses', and help's clothing and hands. The
elimination of carpets, large rugs, window roller shades,
and decorative drapery in rooms and wards is desirable.
Ventilation in addition to the indirect, forced draft, or
fan — inexpensive and of decided benefit to the patient and
comfort to nurse — may be obtained by providing an inside
awning, fastened to the window and dropped at will over
the head of the bed and patient, leaving the body in a
warm room. If properly arranged, the patient has the
benefit of outdoor air and is protected from draft and
storm. Loud talking or laughing by doctors, nurses,
visitors, or patients should be prohibited. Noise from
slamming doors, dropping things, or swishing of over-
starched skirts can be and should be minimized. Odors
fiom medicines, drugs, or chemicals that are useless or
not essential — i. e., iodoform, lysol, etc. — or from general
or diet kitchens, or from lack of ventilation, are inexcusa-
ble. Smoking in a hospital (except in a room especially
prepared and that the farther away the better) should be
peremptorily forbidden. Any person who smokes in a
hospital or enters a sick room with tobacco smoke, fresh
or stale, in his clothes or on his breath, should be forbid-
den the privileges of the institution.
Better team work, better laboratory work, better ca.«e
work, more scientific medical and surgical work, more au-
thority given to the superintendent, one head — and eternal
vigilance — these are the watchwords.
Patiently we await the detailed report of the Standardi-
zation Committee, but in the meantime and all the time,
remember and never forget, first to be considered is the
comfort, safety, and welfare of the patient.
NURSING SIX MILES FROM THE GERMAN LINES
La Panne, in Free Belgium, Site of An Interesting War
Hospital — Scientific Character of Work Done
One of the most interesting of war hospitals is the
Hopital de I'Ocean at La Panne, planted on the little
strip of Belgian soil undesecrated by the foot of the in-
vader, and only six miles from the German lines. Not
only a hospital, but a university, with a cosmopolitan
staff — the nursing staff including English, Scotch, and
Irish, French, Belgian, and Canadian nurses — the work
under the control of Dr. Depage, with Miss Violetta
Thurstan as matron, is of a very fine order.
As an instance of the scientific character of the work,
it may be mentioned that, in the case of wounds, a
"microbe chart" is kept, in addition to those with which
every nurse is familiar. If the chart does not show a
regular diminution, the reason why is thoroughly inves-
tigated. The result is that the majority of wounds speedily
become microbe-free; they are then sutured and treated
as aseptic wounds.
The nurses have their own club, maintained by a small
subscription from each member. Formerly an ordinary
wayside inn, it stands close to the Plage, over which
sweep the health-giving winds from the North Sea. It is
a center of social life, and its activities include gymnasium
classes, an arts club, and concerts. There is also a very
useful mortuary society, to which forty people — doctors,
nurses, and orderlies — belong. Each pays 50 centimes a
month, and the little chapel has been adequately equipped
and is reverently cared for by the members.
It is difficult to realize that all this well-organized pro-
fessional and social life goes on within range of the Ger-
man guns. The protection of the hosiptal is that the
enemy has also a hospital some six miles from the fron-
tier, and they have received notice that any attack on the
Hopital de I'Ocean would at once mean reprisals. So,
though shells whistle overhead, the hospital has been safe,
and, with its avant poste close to the frontier, carries on
its invaluable work. — Canadian Nurse and Hospital Re-
I hold every man a debtor to his profession; from the
which £. men of course do seek to receive countenance and
profit, so ought they of duty to endeavour themselves by
way of amends to be a help and ornament thereunto. —
Bacon.
114
THE MODERN HOSPITAL
MOBEMN HOSPITAL
EDITORIAL AND PUBLICATION OFFICE.
58 East Washington Street, Chicago.
Henry M. Hard .
Frederic A. Washbo
Winford H. Smith
S. S. Goldwater .
W. L. Babcock .
John A. Hornsby .
EDITORS.
. . . Fidelity Building, Baltimore
1 . Mass. General Hospital, Boston
Johns Hopkins Hospital, Baltimore
. . Mt. Sinai Hospital, New York
Grace Hospital, Detroit
58 East Washington Street. Chicago
SUBSCRIPTION.
Domestic postage. $3.00. Foreign postage. $3.50 (15 Shil-
lings). Single copies. 35 cents.
Domestic rates include United States, Cuba, Mexico,
Porto Rico, Canal Zone, Hawaii, and Philippines,
Contributors, subscribers, and readers will find im-
portant information on advertising page 42.
J
CIS
303
The Training of Nurses in Military Hospitals
How may this country, to which the whole
world looks today for trained nurses, best and
most quickly meet the national and world-wide
need for adequate nursing forces to care for our
sick and injured soldiers, and the reconstruction
to come here and abroad, and how may we do it
without depleting the nursing resources of the
country? This question is scarcely second in urg-
ency and importance to the problem of putting
fighting men at the front. Several answers have
been suggested, of which two chiefly have received
serious consideration, namely, the training of
nurses in military hospitals, and the training of
nurses' aids. The government has adopted the
former solution of the problem, but, we under-
stand, only in a tentative way. Since we are all
interested only in securing the best and speediest
settlement of the question, and since time is of
such vital importance, an unprejudiced discussion
of the arguments for and against both plans should
be serviceable. There are two main considera-
tions; first, "Which plan will best meet the na-
tion's needs, both civil and military?" and, after
that — a long way after, but still very important —
"Which will best serve the interests of the nurs-
ing profession?"
The nation needs at present, we are told, a nurs-
ing organization of not less than fifty thousand
women — and needs them quickly. Graduate
nurses it should have by all means, if possible —
but a woman with training enough to enable her,
under the direction of a fully trained nurse, to
make a bed or put on a bandage— today — is worth
more than a dozen of the most highly accom-
plished nurses that can be turned out in any school
in the world after the war is over. The army
nursing school cannot help us today, for the first
of its graduates will not be seen for at least two
years and four months. If the war should last
that long, we shall then be just beginning to put
the resources of the army nursing school to the
test. Waiving for the moment the factor of im-
mediate urgency, the questions arising in regard
to the army nursing school are: From what
source will the supply of pupil nurses come ? How
will it be trained and controlled? After the war
is over, how will it be disposed of?
The supply of young women who will enter the
training schools to be established in connection
with military hospitals will be found, we believe,
to be essentially the same as the supply that
usually enters civilian hospitals, augmented by
those who would not have entered the nursing
profession e.xcept from motives of patriotism.
The more dramatic atmosphere of the military
hospital and the larger remuneration offered is
going to attract from the civilian hospitals the
majority of the best candidates for nurses' train-
ing. We very seriously fear that the civil hos-
pitals, already strained to the breaking point, will
be nearly or quite crippled by the establishment
of training schools in the military hospitals.
As for the question of training, it is to be pre-
sumed that those responsible for the establish-
ment of army training schools have worked out
plans whereby the personnel of the supervisory
forces, medical officers, and chief nurses, may be
kept sufficiently stationary to give the necessary
instruction; but we question whether this is not
an unnecessary duplication of already existing
machinery and organization for training young
women under safer auspices than those of military
camps.
We can see no answer to the third question, how
the nurses trained in the army schools are to be
disposed of after the war, except that indicated
by Dr. Goldwater in the June issue of The Mod-
ern Hospital. "If the army schools succeeded in
attracting the number of women required to staff
the military hospitals of the country during the
long war," says Dr. Goldwater, "(and it must do
this if it is to succeed in any large sense without
THE MODERN HOSPITAL
115
diverting probationers from the ciril hospitals),
there would be an excessive number of profes-
sional nurses in the community immediately after
the war; competition would be intensified, and
professional standards would be endangered."
Perhaps those responsible for the army nursing
school plan have foreseen and provided against
all these objections. So far, however, no ade-
quate replies to the foregoing arguments have
reached us.
On the other hand, among the advantages of
the nurses' aids are that they could be organized
and trained without depleting the supply of
nurses needed for the protection of the public
health ; they could be trained in either civil or
military hospitals. As they would be employed
only under the supervision of graduate super-
visors, they could be used as probationers or
junior nurses are used, releasing many of these
for service elsewhere. While they would not take
three years' training, this need not interfere with
the accepted standards of the three-year graduate,
for, after the war is over, those nurses' aids who
did not wish to enter accredited schools for fur-
ther training would return to civil and non-pro-
fessional life. Above all — and we see no way in
which this advantage can be gainsaid or counter-
balanced— we should not have to wait for over
two years, while our boys are bleeding and dying
at the front, for a sufficient number of women to
give them needed care, and we should not be mak-
ing an unnecessary sacrifice of our civil hospitals,
public health welfare, and private citizens.
A Plea From the Front for Nurses' Aids
After the foregoing editorial was in type, the
following letter, written to a prominent hospital
man in this countiy, was forwarded to us by the
original recipient. The writer, also one of the
leaders in the hospital profession, is in command
of a base hospital in France, having been "over
there" almost from the time of our entrance into
the war.
"For some time I have had in mind to write you in
reference to the inevitable shortage of nurses if the war
lasts more than six or eight months longer. It is be-
lieved that if the war continues beyond that time, our
nurse personnel ■will have to be augmented by nurse-aids,
whose training should be commenced at once.
"It is suggested that the experience of the British in
that connection serve as our guide. The V. A. D.'s have
certainly saved the day in the British nursing field. Their
casualty clearing station and base hospital service would
have broken down \vithout their assistance. They are
used as anesthetists, after some training, as nurse helpers,
and even as ward nurses — with generally good results.
"It is noted that strenuous efforts are being made by
leaders in the nursing profession to obtain additional
pupils for the standard three-year nurse training course.
It would seem to me that this is ill advised, as the neces-
sity for additional nurses beyond the available supply will
be extremely urgent eight months or a year hence. It
would seem to be better foresight to devote a part of the
equipment and opportunity in existing training schools to
training nurse-aids intensively for a period of six months.
If aids thus trained were available, we would then be able
to use graduate nurses as charge-nurses of groups of two
or more wards, with one or two nurse-aids on each ward.
By thus dividing the work, the quality of the nursing
care would be kept up to a very good standard.
"It is believed that a six months' course, properly
planned and carried out in our large civil hospitals in the
States, would, in the emergency, adequately fit young
women of the proper caliber for nurse-aid work. Candi-
dates for this short period of training should be most care-
fully selected, preferably over 21 years of age, and the
selection should be in the hands of competent training
school superintendents. It is my opinion that if the oppor-
tunity for such training and service received public an-
nouncement throughout the States, there would be plenty
of desirable applicants for this work.
"Knowing your breadth of vision and great influence
in the hospital and nursing field, I take the liberty of call-
ing your attention to the opportunity for service that
will probably be offered if the war continues many months.
You will realize that, in order to bring about definite
action, it will be necessary for prompt discussion of the
subject in the States, and an early understanding with the
Surgeon-General's Office."
The standing and experience of the writer of
this letter make comment on our part unneces-
sary. We hope that this plea will receive careful
consideration.
A Patriotic Duty of Hospitals During the War
The United States is now in the war. The na-
tion is getting its stride. The changes and read-
justments that are required for the effective con-
duct of the war are difficult, and are becoming
more difficult every day, but they are never im-
possible. Of necessity, the business of the coun-
try has been reorganized ; the same imperious
necessity calls for the reorganization of the civil
hospitals.
Up to the present time, the enrollment of medi-
cal men has kept pace with the army's growth.
But a million Americans have now taken their
place in the fighting line ; ships are available for
the rapid transportation of a second million; a
third million is streaming into the training camps,
and more doctors are needed. The hospitals of
the country must help to furnish them — they can
if they will.
By undertaking to retain in its service only the
actual number of men required to care for its
patie-^ts, the hospitals can at once release a large
number of physicians for army service. EVERY
HOSPITAL THAT HAS NOT ALREADY DONE
SO SHOULD AT ONCE PLACE ITS STAFF ON
116
THE MODERN HOSPITAL
A WAR FOOTING BY ABOLISHING THE RO-
TATING SERVICE.
What is the rotating service? It is a plan of
organization which requires or permits two, three,
four, or even six men, each serving six, four,
three, or perhaps only two months, annually, to
hold down one man's job. There may be reasons
of educational policy which justify a rotating
service in ordinary times; today any such plan is
contrary to the national interest and is self-con-
demned. In this crisis no plan of organization is
admissible which does not release every compe-
tent physician who can be spared for military
duty. No man should be permitted to excuse him-
self from entering the Medical Reserve Corps on
the plea that a hospital needs him, unless his pres-
ence in that hospital is indispensable — not two,
three, or four months in the year, but all year.
For the period of the war the rotating service
must go. The continuous service plan is the only
patriotic plan of hospital organization at this time.
ONE JOB, ONE MAN! It is the duty of hospital
authorities to adopt this plan now, and to make
it plain to the men who are thus released from
hospital service for the period of the war that
the purpose of their release is to make it easier
for them to decide where the path of duty lies.
S. S. GOLDV^'ATER,
Committee An
Hospital Association.
The Organized Practice of Medicine
That the practice of medicine is on the eve
of a new era, which may ultimately prove to be
nothing less than revolutionary in character, no
one can doubt who knows the field even moder-
ately well. This era may be termed the era of the
organized practice of medicine. Manifestations
of it are arising on every hand, and with increas-
ing frequency.
This era is being ushered in by at least four
outstanding influences: (1) the exigencies of the
war; (2) the health education propaganda ; (.3) the
cost of medical equipment; (4) greater financial
returns to physicians.
As the war progresses, and physicians and sur-
geons in ever-increasing numbers are drawn into
the military service, an almost unbearable burden
is being thrust on those who remain. If for no
other reason than that of self-defense, these phy-
sicians will be compelled to combine in some form
of organization that will enable them to treat
larger numbers in less time and more readily than
they are now able to do. This tendency towards
the organized practice of medicine is bound to
receive a strong impetus after the close of the
w-ar, when the physicians and surgeons now in the
service return to civil life. In cantonments and
base hospitals, they are now learning to work
under orders and as parts of a great organization.
This experience is bound to teach them the value
of cooperation and coordination, and many will
not be willing to return to the old individualistic
type of practice.
The various educational campaigns for health
now carried on so vigorously by national and
state agencies are educating the public, not only
in the fundamental laws of good health, but also
to recognize and demand efficient medical service.
This efficient medical service, which, as the more
discriminating are fast coming to see, cannot in
many instances be rendered by any one individual
physician, however well trained and capable he
may be.
The equipment now demanded by modern medi-
cine for accurate diagnosis and efficient treatment
is such that few physicians are in a financial posi-
tion to install it in their private offices. The
x-ray, the laboratory, hydrotherapy and electro-
therapy apparatus, are all being called into serv-
ice now. All of these it is possible for physicians
to have under some form of organized practice;
individually, except in rare instances, it is not.
And even though they can afford to possess them,
they are unable to employ them with the high
degree of skill attained by men who use them
daily and who are especially trained in these sep-
arate branches of modern medicine.
Furthermore, as Dr. Warner indicates in his
article on the "Evening Pay Clinic," published
elsewhere in this issue, under a system of organ-
ized medical practice, the average net income of
physicians would be markedly greater than it is
today. Dr. Warner points out that the medical
profession of England was at first somewhat skep-
tical about the panel system for their compen-
sation in state insurance ; but it is now an estab-
lished fact that these physicians are getting more
money for their services than they had ever re-
ceived before. When we consider that half a doc-
tor's income is required for the necessary expense
of equipment, office, automobile, etc., and that he
can work for seven hours a day, at the rate of
five dollars for two hours, paid in some of the
existing evening pay clinics, and thereby secure
the equivalent of a ten-thousand-dollar cash prac-
tice, we get some conception of what physicians
could do under an organized practice.
The organization of medical practice is inevit-
able. What is not so clear is how physicians gen-
erally will react to it. Will they welcome it as a
means of rendering a wider and more efficient
service, or will they take the attitude of the hand
worker towards machinery when it was first intro-
THE MODERN HOSPITAL
117
diiced? Will they approach the change with a
sense of inevitableness, not altogether free from
apprehension and rebellion? Or will they wel-
come it gladly, seeing in it a larger measure of
freedom from the harassing consciousness of
work poorly done, often through no fault of their
own, and the possibilities of a larger and more
efficient service?
Vital Issues to Be Decided by Hospital People
There is some danger that, unless hospital peo-
ple have their attention called to the momentous
nature of the issues awaiting their attention, the
approaching meeting of the American Hospital
Association may be neglected. These are war
times, and anything short of life and death that
does not bear on the war sinks into insignificance.
Hospital people need to realize that the American
Hospital Association this year deals with war
issues and likewise with issues of life and death.
It may very well be that the fate of the civil
hospitals of the country depends on the prepared-
ness of hospital people to decide wisely the ques-
tions which thrust themselves foi'ward for con-
sideration at this meeting. This is a war meet-
ing, as the secretary announces. Now, the war
is not something that the hospitals can consider
solely from the point of view of the number of
stars in their service flags and the number of
Liberty bonds bought by their employees; it is
a maelstrom in which the hospitals themselves
may be w^recked unless they are guided by the
most far-seeing wisdom. Dr. Goldwater sounded
the note of warning in these columns last month,
when he declared that "the civil hospitals of the
country are being gripped by destructive forces,"
and called on "those who are conscious of this
tendency" to oppose it in the interest both of the
army and the civil population. The Modern Hos-
pital has pointed out more than once before and
as events abroad seem to demonstrate, the morale
of an army depends largely on the morale of the
civil population at home. In war, of all times,
we cannot tolerate sickness and the resulting in-
efficiency. Now, with so many of our physicians
away at the front, hospitals are more necessary
to the health of the community even than they
are in times of peace. For the sake of victory
and national preservation, therefore, we must not
let the civil hospitals be wrecked. We must con-
sider, among the other topics suggested by Dr.
Goldwater, the prevention of the further breaking
up of the teaching staffs of nursing schools and
the relief of communities which, as a result of
the war, are left without adequate medical and
nursing service.
Closely connected with this is the subject, more
fully di.scus.sed in another editorial, of providing
a supply of nurses for our army.
Another vital topic which must, we believe,
come up for consideration at this meeting is the
standardization of hospitals. It is most unfor-
tunate that just now, when their counsel is so
much needed on this subject, so many of our
hospital administrators should be of necessity
wholly absorbed in other matters. This has
thrown the burden of hospital standardization
almost entirely upon others who, though just as
deeply concerned for the best interests of the
hospitals, are less intimately acquainted with the
problems of the hospital as a whole. Admirable
work has been done by the American College of
Surgeons, but the college itself no doubt realizes
that, to carry out to a successful issue a real pro-
gram of standardization, the aid of hospital peo-
ple is required. It is necessary that hospital
people give the subject their most earnest con-
sideration.
For these and many other reasons, it is most
important that there be a full attendance at the
Atlantic City meeting. We hope that no one will
fail to realize the importance of this to the country
and to the hospitals themselves.
Staff Standardization and Hospital Standardiza-
tion
On another page will be found an account of
the third annual meeting of the Catholic Hospital
Association. As will be seen, the association has
pledged itself to the hospital standardization pro-
gram of the American College of Surgeons, com-
prising the installation of adequate case records,
the abolition of fee-splitting, and the establish-
ment of suitable laboratory facilities. When these
three desiderata shall have been secured in hos-
pitals throughout the country, the level of medical
and surgical practice in them will be immeasur-
ably raised. We extend our heartiest congratula-
tions to the Catholic Hospital Association for thus
putting itself in the forefront of progress, and to
the American College of Surgeons for having
pointed out the way.
We understand, however, that the first step in
the standardization program contemplates the
marking of hospitals on the sole basis of these
three criteria, namely, establishment of case rec-
ords, abolition of fee-splitting, and utilization of
laboratory methods, hospitals not being graded
according to degrees of merit, but marked simply
as meeting or failing to meet the standard set;
and we confess to being a little puzzled by such
a method of standardization. The American Col-
118
THE MODERN HOSPITAL
lege of Surgeons, we understand, defines "hos-
pital standardization" as "staff standardization" ;
and this definition, too, puzzles us a little. In the
first place, "hospital standardization," to hospital
people, means, as a matter of course, standardiza-
tion not merely on the basis of medical and surgi-
cal care alone, but on the basis of everything that
can affect the patient's safety and well-being —
adequacy of nursing service, construction of
buildings, organization of housekeeping service,
and soundness of financial methods. In the sec-
ond place, many hospitals, owing to local condi-
tions, are unfortunately so dominated by self-
seeking staffs that to propose to mark the hos-
pital on the basis of staff efficiency alone seems
somewhat like the proposition of a school inspec-
tor to pass or not to pass the pupils on the basis
of their parents' intelligence. It is quite true
that to pick out intelligent parents is about the
best thing one can do to lay the foundation for a
good education; but it might seem discouraging
to tell a child that all his subsequent devotion to
grammar and arithmetic and geography, etc.,
count for nothing. Similarly, we fear that mark-
ing on the sole basis of staff efficiency may be a
little discouraging to a hospital in which a hard
fight has been waged — perhaps against an indif-
ferent board and a neglectful staff — for efficiency
in all hospital essentials.
Seriously, we hope that any organization which
may undertake to standardize hospitals will do so
with the broadest and most enlightened concep-
tion of the task. The reform of staff abuses
which the American College of Surgeons has
undertaken cannot be too highly commended;
it is perhaps the one essential preliminary to the
successful standardization of hospitals. But we
fear that a standard based on staff efficiency alone
will inevitably be found so inadequate and unsat-
isfactory as to lead to the establishment of some
rival system of standardization. We hope that this
most undesirable complication may be avoided.
Consolidation of the Editorial and Business Offices
of The Modern Hospital
This number of The Modern Hospital is is-
sued from the new address, 58 East Washington
Street, instead of 111 West Washington Street,
and by the time this copy reaches its readers
the consolidation of the editorial and business
offices at the foregoing address will probably have
been completed. It has become increasingly clear
as time went on that The Modern Hospital
could render more efficient service to its readers
by a closer departmental cooperation, particularly
between the editorial and statistical departments,
than was possible when these were separated by
the distance between Chicago and St. Louis. All
departments formerly situated in St. Louis, there-
fore, have been removed to Chicago and are now
under one roof with the editorial department.
THE LATCHSTRING OUT
The Modern Hospital is now "at home" to its friends
in its new offices at 58 East Washington Street, suite 1419.
It is our fervent hope to induce Dr. C. E. Sampson of
Cottage Hospital, Creston, Iowa (mentioned in the "Field
Editors' Notebooks" this month), to write down what he
told us on a recent visit here about the tribulations of a
hospital that aspires to be a community center, while
beset by politicians that "wrap themselves in the stars
and stripes and make a noise like a patriot." In order
to maintain his hospital as the educational center for which
it was intended, Dr. Sampson has had to organize all the
progressive enlightened forces of his community, and even
to buy and run a newspaper.
Dr. F. K. Camp, superintendent of Wesley Hospital,
Oklahoma City, believes that his institution has a service
flag that can compare vidth that of any hospital of its
size in the United States. Wesley Hospital, at the time
we had the pleasure of seeing Dr. Camp, had sent to
serve under the colors fifteen physicians, including the
chief of staff, and ten nurses, with ten more to follow.
The medical staff consisted of one man who could not
pass the physical examination for the army, having had
infantile paralysis, another over the age of fifty-five, and
two women physicians. Dr. Camp himself has informed
the government that he is ready to close the hospital and
go to the front himself whenever our government says
the word.
Dr. E. H. Lewinski-Corwin, who has been selected to
direct the study of the dispensaries of New York City for
which the Rockefeller Foundation voted ten thousand
dollars to the public health committee of the New York
Academy of Medicine, when in Chicago recently, kindly
furnished us with the following outline of the question-
naire which he has prepared for use in this investigation:
Total number of dispensaries connected with hospital.
Chronological table showing dispensary treatments, diseases treated,
etc.
Record number and total number of patients.
Legal proofs concerning dispensary service and staff. This would
include staff and various clinics open throughout the year and hours
at which clinics were operated. Number of physicians available at
certain periods of the year, say in August, September, April, etc.
Total number of pay and nonpay patients.
Total number of paid and unpaid physicians. Length of service.
Special service, dental, etc.
Could patients contribute more and should they?
What is known of financial standing of patients ?
Relation of the Out-Patient Department to the hospital.
Organization of methods of handling patients to reduce waiting
time of patients (lectures, pictures, and luncheons for patients while
waiting) .
Medical Histories, manner of taking histories, recording, etc.
Influence of evening clinic.
Equipment of evening clinic.
Service of evening clinic.
Dr. Rosetta Sherwood Hall, who for over twenty-five
years has worked as a medical missionary in Korea, on
THE MODERN HOSPITAL
119
a recent visit here toUl us most interesting things in
regard to hospital conditions in that far-away land.
The hospital shown in Figure 1 was built in Pyeng
Yang, Korea, by Dr. Hall in 1909. Dr. Hall was com-
pelled by force of circumstances to be the architect, chief
contractor, and "boss" carpenter, for the masons were
Chinese, and the Korean carpenters had never seen such
a building. The governor of Pyeng Yang was invited to
Fig. 1. The Hospital of Extended Grace to Women and Children, de-
signed and built by Dr. Rosetta S. Hall at Pyeng Yang, Korea.
name the hospital, and out of gratitude to Dr. Hall for
having cured his wife, he called it "The Hospital of
Extended Grace to Women and Children." She has been
good enough to write a little paper on the subject, which
will be published in an early number.
The second illustration shows Dr. Hall in her consulta-
tion room, with a glimpse beyond of the treatment room,
where an assistant is giving a throat treatment. To the
right stand two attendants who receive and check the
Fig. 2. Dr. Hall
her consultatic
in the Hospital of Extended
shoes of the Korean patients as they enter, much as
attendants in public places here check outer wraps and
men's hats. Among the customs which Dr. Hall thinks
we might well learn from the Koreans is that of keeping
floors free from street dirt and the marks of shoe-nails.
Korean floors are kept clean enough to eat on and sleep
on, and are used for both purposes.
The two attendants just mentioned are both blind. The
condition of blind girls in Korea is extremely pitiable, for
according to native heathen custom they are left in
ignorance, or are sometimes trained as sorceresses or
fortune-teller.s. Dr. Hall's interest in the blind girls of
Korea was early awakened, and in 1897 she perfected her
system, adapting New York Point to the Korean language,
and embossed the first books for the Korean blind before
the apparatus arrived from New York.
The third picture shows the children's ward in the Hos-
pital of Extended Grace. It is named the "Edith .Margaret
Fig. 3. The Edith Margaret Ward in the Hospital of Extended Grace.
Ward" in memory of Mrs. Hall's little daughter. The
picture was taken in the winter of 1909-10, before the
wards for adults were in use. The patients, it will be
seen, are on this floor. Korean floors are not only clean,
but artificially warmed, and Koreans regard it as a great
hardship to have to sleep on chilly "foreign" beds. While
there is a "foreign bed ward" in the Hospital of Extended
Grace, Dr. Hall has found the warm floor beds so advan-
tageous, particularly in postoperative cases, that she has
put them in general use.
Fig. 4. This group shows, from left to right, seated, the two Drs. Kim
and Dr. An, the first three women to graduate from the govern-
ment medical school at Seoul, Korea ; standing. Dr. Rosetta S. Hall,
Prof. Okada. Dean Sato, and Dr. Mary M. Cutler.
The fourth picture shows the first three women to receive
a degree from the government medical school in Seoul.
In the upper row, on left (reader's) stands Dr. Hall and
on the right a colleague. Dr. Mary M. Cutler, while in the
center are two Japanese officials. Dr. Hall found the
Japanese very broad-minded and helpful — more so indeed,
than Western physicians — toward the plan of educating
Korean women as physicians. Women physicians are
necessL y in Korea, for custom does not permit women to
receive medical attention from men.
Worry is rust upon the blade. — Henry Ward Beecher.
120
THE MODERN HOSPITAL
PROGRESSIVE ACTION TAKEN BY CATHOLIC
HOSPITAL ASSOCIATION
Washable Uniform for Sisters, Controlled Staffs, Adequate
Case Records and Laboratory Facilities Approved
— Fee-Splitting Condemned — Some of the
Papers Read — A Notable Meeting
The Catholic Hospital Association met in Chicago, June
18, 19 and 20 at St. Xavier's Academy. The sisters of
St. Xavier's deserve warm
thanks from the association
for the way in which they ar-
ranged accommodations for
the visiting sisters and guests.
Over two hundred Catholic
hospitals, representing several
of the sisterhoods who are con-
secrated to the care of the
sick, were present.
The meetings opened with a
mass in the chapel of the
school, attended by all the hos-
pital delegates, priests, sisters,
and guests of the association.
The Rev. Father Charles B.
Moulinier, S. J., regent of the
Marquette University School
of Medicine and president of
the Catholic Hospital Associa-
tion, delivered the opening
address. Father Moulinier has
given the greater part of his
time during the last few
months to the study of hos-
pital conditions. He is heart
and soul in the work of better-
ment of the Catholic hospitals.
His address is published here-
with.
Mr. John G. Bowman, direc-
tor of the American College of
Surgeons, explained the pur-
poses of the movement undertaken by the college for the
standardization of the hospitals and something of the
fundamental things which the college believes to be neces-
sary to give the very best service to the patients. Mr.
Bowman told of some of the abuses current in hospitals
today which could be eliminated by the keeping of com-
plete case records and their use by the staff and the gov-
erning authorities to keep watch of the grade of work
being done by the medical men who bring patients to the
hospital.
Dr. A. J. Ochsner, F.A.C.S., of Augustana Hospital,
Chicago, read a paper on "The Model General Hospital,"
which is published following the report, illustrated with
a wall chart showing a plan
for the organization and con-
trol of various departments,
some by the superintendent
and others by the direct ad-
ministration of the staff.
Among the latter were the
training school and the super-
intendent of nurses.
Dr. Roger T. Vaughan of
Cook County Hospital, Chi-
cago, had for his subject "The
Importance of Autopsies."
Dr. Vaughan gave important
data to prove the value of
autopsies in final diagnosis,
and read considerable history
on this matter to show that
the making of autopsies was
not disapproved by church
authority.
Dr. William Carpenter Mc-
Carty, of the Mayo Clinic,
Rochester, Minn., brought to
the association much valuable
information concerning the
laboratories and the work of
the technicians at St. Mary's,
that famous hospital which is
conceded to be an authority
on group diagnosis.
"The Hospital's position in
the Education of the Doctor"
Fred C. Zapffe, secretary
American Medical Colleges,
S.J., regent Marquette University
Catholic Hospital Association.
Dr.
of
was presented by
of the Association
Chicago.
Dr. William J. Mayo of Rochester,
Minn., who was to
THE MODERN HOSPITAL
121
have opened the second day's meeting on Wednesday, was
not able to be present.
"Group Diagnosis and Treatment" was discussed in detail
by Dr. Louis F. Jermain of Milwaukee, Wis.
Dr. Joseph Byrne of the Neurological Hospital, Black-
well's Island, N. Y., gave an interesting talk on "The
Patient's Mind and The Importance of Social Service for
the Future Welfare of the Patient." Dr. Byrne, with a
sympathetic understanding of his subject, dwelt on the
necessity of the study of the neurological patient from the
human as well as the scientific
standpoint.
Dr. Charles E. Paddock of
St. Luke's Hospital, Chicago,
111., read an exceptionally good
paper on "The Hospital and
Obstetrics — the Saving of the
Seventh Baby."
"Better Care of the Physical
and Mental Health of Sisters
and Nurses" was urged by Dr.
Charles M. McKenna of St.
Joseph's Hospital, Chicago.
Dr. McKenna suggested moie
frequent and thorough general
physical examinations for the
women engaged in hospital
work.
The Thursday session was
opened by Mr. John G. Bow-
man, who spoke on "The Busi-
ness of Medicine and the Pro-
fession of Medicine." An
abstract of his address will
be found on succeeding pages.
The following resolutions
were adopted by a rising vote
and without any dissent or
discussion. They will form
part of the platform of the Catholic Hospital Association.
1. Resolved, That we. the Catholic Hospital Association of the United
States and Canada now assembled at Chicago in our third annual con-
vention, approve of the work being done by the American College of
Surgeons for the standardization of hospitals and assure the College of
our fullest cooperation in its endeavor for the betterment of hospitals
and the resultant increased welfare of mankind.
2. Resolved, That we. the members of the Catholic Hospital Associa-
tion now assembled in Chicago, do hereby declare our desire to adopt
a washable uniform or gown, along with a curtailed veil, to be worn
when in actual service of the sick, in so far as it will meet with the
approval of our superiors and be in keeping with the spirit and tradi-
tions of our respective orders or congregation and meet with sanction
of ecclesiastical authorities.
3. Resolved, That we, the membei-s of the Catholic Hospital Associa-
tion call upon all of our members who are sisters to become, as far
as practicable, registered nurses ; and to establish training schools for
nurses wherever and whenever practicable. To the various state
boards of our respective states and provinces we pledge our determined
efforts to cooperate in maintaining the highest reasonable standards
in our training schools for nurses and in all other health service that
comes under their jurisdiction, and
within the sphere of our activities.
4. Resolved, That we, the members
of the Catholic Hospital Association,
pledge ourselves to organize con-
trolled staffs in our hospitals : to
establish or continue an adequate
system of case records, with a sister
in charge, having full authority to
demand the careful cooperation of
doctors, interns, and nurses : and to
require of our staffs a monthly or
bimonthly analysis of these records ;
to secure from our superiors, staffs,
or friends funds to properly equip
all necessary laboratories and to
bring about as soon as possible the
scientific training of our sisters and
technicians of all kinds, anesthetists,
dietitians, record-keepers and social
service experts. We further pledge
ourselves to urge all surgeons who
are privileged to practice in the hos-
pitals of the association, and who are
not at this time Fellows in the
American College of Surgeons, to
qualify, as soon as they are able,
for Fellowship in the college. We
further wish to express our desire
that all doctors who practice in our
hospitals be or become, as soon as
practicable, members in good stand-
ing of their respective county medical
societies and contribute their share
to the active medical life of said
societies. We further wish to express
our conviction that the secret division of fees as condemned by the
American College of Surgeons is an unethical and nefarious practice
which we pledge ourselves to keep out or root out of our hospitals.
T'le following officers of the association were elected
for the coming year: honorary president. Most Reverend
Sebastian Gebhard Messmer, D.D., D.C.L., archbishop of
Milwaukee; president, Rev. Charles B. Moulinier, S.J.,
regent, Marquette University School of Medicine, Mil-
122
THE MODERN HOSPITAL
waukee; first vice-president, Sister Mary Joseph, St.
Mary's Hospital, Rochester, Minn.; second vice-president,
Sister Mary Esperanz, Minneapolis, Minn.; third vice-
president, Sister Mary de Pazzi, Toronto, Ontario, Canada ;
Fig. 4. Dr. B. F. McGrath, Marquette University School of Medicine,
Milwaukee, secretary-treasurer Catholic Hospital Association.
secretary and treasurer. Dr. B. F. McGrath, Marquette
University School of Medicine, Milwaukee; executive
board, Dr. Joseph Byrne, Fordham, New York; Sister
Mary Regina, Wilkes-Barre, Penn. ; Sister Mary Con-
stance, Baltimore; Sister Mary Ursula, Ann Arbor, Mich.
PAPERS READ AT THE CATHOLIC HOSPITAL
ASSOCIATION CONVENTION
The following are some of the papers read at the Third
Annual Convention of the Catholic Hospital Association.
Others will be presented in later issues.
President's Address
This is our third annual convention of the Catholic Hos-
pital Association.
In the first convention we gave our best efforts to bring-
ing clearly before our minds the great fundamental fact
that a hospital is an educational institution, just one fac-
tor, and that a very lai-ge factor, in medical education.
No matter where the hospital, no matter what its size, no
matter what its other struggles, thei'e was just one con-
stant duty to perform — the educating of every one in the
hospital, from the highest surgeon to the merest orderly
or engineer, in the matter of taking proper care of the
sick. The doctor must learn and teach all the while in
everything he does, whether surgeon or internist. The
intern, if there be any such in the hospital, must be learn-
ing and teaching all the while. The nurse, from the
probationer to the graduate, must be learning and teaching
all the while. The laboratory technician, the clerk, the
superintendent, the orderly, the engineer, must be learning
and teaching all the while just one thing, namely, how to
take ever better care of the patient. The patients, every
one, from the youngest to the oldest, man, woman, or
child, must likewise be learning and teaching all the while,
learning how better to take care of self and teaching in
one way or another every member of the staff, of the
intern force, of the nurses, of the managing personnel, how
they have succeeded or failed in doing all they could and
should have done to help the patient to get better, to be
cured, and to remain healthy when he or she leaves the
hospital. More knowledge of medicine, therefore, is learned
and taught in the hospital than in any other of the
institutions concerned with the study of human health.
In our second convention we spent three days discussing
the theme of team-work in the hospital. We pictured the
whole hospital procedure as a game in which the prize or
trophy struggled for was the alleviation or cure of human
ills — the bringing into the life of every patient as far as
medical knowledge could avail, of comfort and pleasure
and health of body, mind and soul, not only for this life
but even, where possible, reaching out into the life to
come.
In both of these previous conventions there was always
one overmastering, controlling point of view, service to
the patient. We never lost sight of the great funda-
mental, ethical principle that the patient has a right to all
the most enlightened, self-sacrificing, scientific, philan-
thropic, and conscientious religious service that body, mind,
and soul of man crave for, need, and have a right to. We
repudiated any such thought as that the hospital is a
mere boarding-house, a place where the surgeon merely
operates, where the internist merely prescribes medicine
or treatment, where the nurse is little more than a cheer-
ful attendant on whims, w'here the intern comes and goes
in his white uniform in the performance of perfunctory
duties, where the sisters and the chaplain are pleasant and
courteous and unobtrusive; and we have taken up with
vigor and are now pursuing, after one year of interruption
in our meetings, with renewed energy the whole-souled
conviction that the work of caring for the sick in our hos-
pital is one of the most complex, serious, coordinated, and
exacting functions that any profession today is called
upon to perform in behalf of its fellow man. Furthermore,
if what we have said in our previous two conventions be
true, we are now logically and inevitably face to face with
a question just as complex, just as serious, just as heart-
searching and conscience-disturbing as any that can be
put to an individual human being or responsible aggregate
of human beings, and the question is this:
Are you performing your full duty to the sick as bound
to do by the laws of man and of God? Are you and your
hospitals and your staffs and your interns and your nurses
and your technicians and your dietitians and your recoi'd-
keepers and your clerks and your cleaning maids and
orderlies and your engineers and all your helpers — are
they, one and all, doing what they can and should for
every patient that comes into your hospitals?
If they are, then you should rejoice in heart and mind
and conscience and go right on ever keeping pace with
the growing truth of medical scientific knowledge and gen-
eral hospital service. If they are not, then here at this
third convention of the Catholic Hospital Association you
must think and search and find out where, in what, and
why that full and best service is not being given in your
hospital and, if possible, determine before this convention
adjourns that whatever is right and good in your hospital
will go on becoming more right and better, and whatever
is poor or bad will be made good and better just as soon
as ability, determination, and concerted effort on the part
of all concerned, superior, staff, intern, nurse, technician,
clerk, orderly, can be brought to understand and appreciate
the sacred obligation resting upon all to give the highest
possible service to the sick.
This, my dear fathers, sisters, nurses and doctors, is
THE MODERN HOSPITAL
123
what standardization means in the mind of the American
College of Surgeons, in the mind of its high-souled direc-
tor, Dr. John G. Bowman. This is what it means in the
mind and soul of the members of the Catholic Hospital
Association. This is what any true, effective, and lasting
standardization must mean. It means, therefore, I go on
to explain, a gathering together into our minds and hearts
and characters a few fundamental and far-reaching prin-
ciples and convictions, a few strong and vital motives,
and a few impelling, mastering determinations all converg-
ing with harmonious cooperation on the one great achieve-
ment to bring into the physical, mental, spiritual, and
religious life of every patient within our hospitals the
fullest possible measure of helpful service.
We are here taking part in these three days' delibera-
tions with a view to coming as nearly as we can to a uni-
formity of view on certain great phases of hospital work.
We are really going to try to get at the philosophy of
hospital service and we are going to make a concerted
effort to understand the SOUL of the hospital. As
you listen to the various speakers, as you gather during
the noon recess and in the evenings, as you talk over in
the conferences the many and varied facts and factors
that enter into hospital life, I beg of you never to forget
in it all that the hospital has a soul, a spirit, a breath, and
a life which is distinctive, which is vulnerable, which can
be killed. To bring out just what I mean, permit me to go
a little further and to say that there are today in this
country strong, robust, living hospitals; there are dying
and dead hospitals; and it is all a question of the spirit,
of the spirit of service, of true service, of unselfish service,
and the heart and the hand and the daily wearing of body
of enlightened service, of service into which go the mind
and soul on the part of every one concerned, in no matter
how insignificant a way, with the care of the sick. And
it is this soul, this life, this spirit of the hospital that we
are going to study these three or four days in order that
we may understand the mind, the heart, the altruistic pur-
pose of the great American College of Surgeons. I say
"great" advisedly because they are showing a greatness
of mind and purpose in their unselfish effort to bring
all the hospitals of this country and of Canada to under-
stand and appreciate from year to year ever more truly
and keenly what high degree of service can and should
be given to the patient in the hospitals of the United
States and of Canada.
The whole world is to be the beneficiary of these efforts.
The patient, th<> doctor, the nurse, and all concerned in
this great struggle to make this mortal life of ours a
healthier, a more enjoyable, and a better life morally and
religiously.
We shall make every effort, I know, to get at the truth
of things medical that enter into hospital life and we shall
unflinchingly accept whatever bui-den this enlightenment
brings to our future efforts in hospital service.
The Business of Medicine and the Profession of Medicine
Francis Bacon abserved some four hundred years ago
that the doctor owes a debt to his profession. Since that
time doctors have liked that observation; over and over
they repeat it. But what is the debt to the profession
which the doctor owes ? Or, to state the question in an-
other way, what is that the doctor owes to his profession
that the business man or the iceman does not owe to his
work? On this basis is there an essential distinction
between a doctor and an iceman ?
The doctor and the iceman have many qualities in com-
mon. Both exert physical energy in their day's routine.
Both become tired and discouraged; both have their mo-
ments in the day's round when they realize some com-
pensation for their efforts outside of a monetary one.
Both the successful doctor and the successful iceman
are intelligent. Any distinction between the two in the
matter of intelligence is one of degree. But for centuries
there has lodged in the public mind a distinction between
the doctor and the iceman. Tradition holds that the doctor
goes to his day's work with an altruism which does not
exist in the heart of the iceman. The doctor, according
to this view, assumes an obligation toward his fellow-
beings which the iceman, admittedly, does not assume.
The doctor is under obligation to consider the interests
of the public as well as his own. Are you satisfied with
this distinction?
The war has brought about some quick revision of popu-
lar notions. An ideal of service is shot into all of us.
Dominated by this spirit the icemen, it seems, recently
held a convention in New York. They pointed out with
sincerity that they are benefactors of humanity; that by
their efforts they save a useful commodity which would
otherwise go to waste; that by the distribution of ice they
save food and relieve human suffering; that they render a
service comparable to that of our highest professions.
We find ourselves proud of the iceman. The iceman
renders a service to humanity; so do the white-wings who
sweep the streets. White-wings prevent disease. Icemen,
white-wings, and doctors usher in human happiness. Serv-
ice to humanity, therefore, is not a distinguishing quality
of the doctor. Neither can we differentiate the doctor's
service from the service of the ti-ades on the ground that
the doctor gives, to a large extent, his services free to
the poor. Grocers also give free food to the poor and
icemen give free ice to many a mother in order that she
may keep milk sweet for her children. What, therefore, is
the special debt which the doctor owes to his pi-ofession ?
In answer to the question, first, the doctor ministers to
his fellow-men at the extremity of life. His patient is
not in normal health. Many times he is close to death
and his mind does not function in its normal fashion. The
patient is defenseless. He must trust the doctor more
absolutely than he has ever been called upon before to
trust his fellow-man. He places his very life in the hands
of the doctor. The first debt which the doctor owes to his
profession is, thei-efore, that he have lodged in his own
heart the essential character worthy of this highest trust
of which we can conceive.
Second, by the very nature of the doctor's work he owes
a degree of honesty to his fellow-man that distinguishes
him from all other folk. The defenseless patient trusts
the doctor utterly. Does the doctor give to his patient
the benefit of the highest knowledge in medicine ? Is he
scientifically honest? Does he bring to bear upon the
complaint of the patient every laboratory analysis and
benefit of thorough physical examination which may throw
light upon the cause of the complaint? Does he follow
the development of the case hour by hour, or day by day,
if need be, in the same spirit? In the answer to these
questions lies a trust, the height of which is not reached
in any trade or business. The doctor's debt to his pro-
fession is that he be qualified by training to answer these
questions with sound science; that he follow his judgment
with performance; and that he have the character to
inform his patient promptly of any inability on his own
part to meet the trust placed in him.
124
THE MODERN HOSPITAL
The General Hospital
By a. J. OCHSNER. M.D., LL.D., F.A.C.S., Chicago.
There are certain fundamental principles which must be
borne in mind constantly in order to make a general hos-
pital perform its highest mission in efficiency and
humanity.
The element of precedent, although valuable, must not
be permitted to prevent progress. It would show as little
wisdom were we to attempt to harvest the great crop
of wheat in our Northwest by hand with the sickle because
our ancestors did this half a century ago as it would
show should we attempt to conduct our hospitals as they
were conducted during the same period because of prece-
dent.
While we are wise to make use of modern farm ma-
chinery, on the one hand we must not accept the wasteful
ways that have come with the new way of doing things,
neither should we abandon one single good trait of the
old hospital management. Above all things, we should
not permit the element of human interest in the patient
and those in distress over his illness to be neglected be-
cause of our ability to deal with his malady in a more
scientific way. By insisting upon having your sister su-
perior of each and every institution a woman with this
deep human interest, you can for all times continue to
maintain this as one of the characteristics of our Catholic
hospitals in the future as you have in the past.
There are two elements which sometimes, though very
rarely, have crept into these institutions because of the per-
sonal characteristics of the one at the head of the hospital.
Occasionally, she has been too much inspired with the idea
of material growth of the institution and has placed the
financial side above all others; still more rarely it has
been the desire to give the religious side of the work due
prominence, not appreciating the fact that by exercising
human interest the highest form of religion can be served.
In the future a third element might be introduced because
it is so common among many of the most highly trained
members of the medical profession, namely, the practice
of becoming so completely engrossed with the scientific
interest in the disease as to forget completely the patient
and his human interests.
Fortunately, heads of the hospitals with these unfor-
tunate tendencies can be placed in positions outside of
hospital management where the very peculiarities which
make them undesirable in the one institution will make
them especially desirable in some other.
With one of the most common faults of many of the
modern hospitals, the element of wastefulness and ex-
travagance, we need not be concerned so far as the man-
agement of Catholic hospitals go, with the exception of the
wastefulness of the medical and especially the surgical
staff, which is very difficult to control in any institution.
In the respect of eliminating waste the Catholic hospitals
stand at the head through wise and painstaking admin-
istration.
Most of our hospitals have gi-own from very small be-
ginnings, and consequently conditions had to be impro-
vised in every detail. The next generation will come into
fully established institutions, and it is important that now
you see to it that an efficient organization be developed
so that these institutions will be able to exercise the
greatest possible good for the coming generations.
HOSPITAL STAFF
One of the most important elements is a thoroughly
competent hospital staff. In the early days an institution
demanding such a staff would have been disappointed in
our present comprehension of the qualifieations for mem-
bers of this body.
Within the period of a few years, it seems likely that
the following qualifieations will be demanded by hospitals
of the members of their staffs.
They must be men above reproach from the standpoint
both of morals and ethics. Hospitals will be unwilling to
have on their staffs a moral degenerate or a fee-splitter
or a man who treats his professional colleagues unfairly
no matter how capable he may be professionally, because
they will feel that they have no right to expose the younger
members of the profession upon the staff to the evil in-
fluences of such a man, and because they will refuse to
be classified with institutions willing to sanction this.
Regarding professional ability and educational quali-
ficatons, we are bound to be in a transitional period for a
number of years to come. Undoubtedly, many of the
most capable men in the medical profession of today have
not enjoyed ideal educational advantages, but they have
made the best of the available advantages, and the results
have been quite remarkable in many instances.
For the present generation all such men should be given
every opportunity to exercise their skill in our hospitals.
Here the element of loyalty which has been so marked in
the past in Catholic hospitals will come into play. A
member of the medical staff who has loyally stood by the
institution during the days of its struggles should not be
dropped by the wayside because under his care and sup-
port the institution has grown to a position in which it
can command men of greater educational qualifications.
This man would, however, not be permitted to keep the
professional side of the institution at the level of his
educational standing by filling vacancies which may occur
with men of the same educational type.
If your hospitals will insist invariably that every new
member of the staff be of the highest type morally, ethic-
ally, intellectually, and professionally, time will do the
rest. In order to do this, two elements must be intro-
duced. You must have a definitely organized staff with
a chief of staff, a chief of every department, associates
and assistants, and a house staff, and at the present time,
I believe, it is well to have a visiting staff. The visiting
staff should have privileges but no rights. It should serve
the purpose of giving desirable members of the medical
profession an opportunity to demonstrate their ability in
order to enable the staff to choose wisely when opportunity
comes to fill vacancies in the regular staff. The members
of the regular staff should have rights as well as privi-
leges. They should recommend through their chief to the
sister superior all matters pertaining to the medical side
of the conduct of the institution.
In case of vacancies, they should recommend but not
appoint men to fill these places. At this point, I wish
to introduce an important principle which has been em-
ployed in European universities for many generations. In
filling vacancies the staff should in each instance recom-
mend to the sister superior not one, but three, candidates,
indicating them, if desii-ed, as first, second, and third choice.
The sister superior should confer with the head of the
department in which a vacancy is to be filled, or, if the
head of the department is to be filled, with the various
heads and the chief of staff, and then she should choose
one of the three or reject all of them. In this manner
the staff cannot force the sister superior to accept a
particular man against her judgment neither can the
sister superior force upon the staff an undesirable member.
THE MODERN HOSPITAL
125
QUALIFICATIONS FOR STAFF MEMBERS
Above all things a staff member must be morally and
ethically beyond reproach, and every one of the new mem-
bers for the junior positions should have the best possible
educational qualifications. They should have an excellent
preliminary education, a thorough scientific college and
first-class medical college education.
Those occupying higher positions should have served
as interns and then as assistants and whenever possible
they should have broadened their education by study
abroad extending at the least over a period of one year.
They should be chosen without regard to their religious
affiliations. Should you limit your choice or even favor
the choice in selecting staff members to those of the
Catholic faith, the institutions would not attain the highest
efficiency because of what might be called harmful in-
breeding.
Undoubtedly, it will be necessary after some years to
introduce the elements of age limit or limit of period
of service in order to strengthen the staff, and maintain
the highest degree of efficiency. At present we need not
insist on the introduction of these elements.
LINES OF AUTHORITY
No modern business would prosper unless it had es-
tablished definite lines of authority. In order that every-
one connected may know his part of the business and mind
it, I would suggest the accompanying outline.
d^:::::
^^K
1
T«Me Ser»lC'
....{:
Hr™
NURSES' TRAINING SCHOOL
The greatest advance in hospital management during
the past century was the introduction of the nurses' train-
ing school.
In the larger cities the Catholic hospitals have an op-
portunity to establish a system which they may conduct,
preferably in connection with any or all of the other hos-
pitals in the city, but, to begin with, it might be best to
start without reference to the others unless it were pos-
sible to interest one or more at the outset. I will submit
for your consideration the following plan, which will, I
think, solve many of the educational difficulties you have
encountered in conducting your training schools.
There should be a central school in each city, with a
teaching force composed of the best teachers from the
various training schools. Two sessions should be held
each day, one from 9 a. m. to 12 m., and the other from
2 to 5 p. m. The work in the afternoon should be a repe-
tition of the work in the morning in order that all of the
nurses should have exactly the same instruction.
All first-year nur.ses in the city should be divided into
Groups A, B, and C.
Group A should be divided into two halves, and this en-
tire group should attend the central school from 9 a. m.
to 12 m. One-half of Group A should go on duty in a
hospital at 1 p. m. and work until 7 p. m., and the other
half should go on duty at 5 p. m. and work until 11 p. m.
The afternoon work is heavier between the hours of 5 and
7 o'clock. There should consequently be as many nurses
on duty at this time as during the forenoon hours. Groups
A and B should contain each two-fifths, and Group C one-
fifth of the total number of nurses.
Group B should go on duty in the hospital at 7 a. m.
and work until 1 p. m., and then this group should attend
the central school from 2 to 5 p. m.
At the end of every month half of group A would
exchange places with Group C. At the end of six months
Group A and Group B would change places. In this man-
ner all of the members of Group A would have their night
duty during the first six months, while the members of
Group B would have night duty during the second six
months of the year.
EDUCATIONAL PROVISIONS
Every hospital should represent an important element in
the educational system of this country. It is unreasonable
to permit the wonderful educational facilities to be wasted
which will be available when every member of every hospi-
tal staff shall have been selected for his high moral, ethical,
educational and professional qualities. Such forces should
be employed systematically and universally in the educa-
tion of the future members of the medical profession.
If we give our attention to this element with intelli-
gence and judgment, we shall have at our command with-
out cost the most powerful means of educating the coming
generations.
The work will have to be systematized. A plan has been
in operation in two of my hospitals for a number of years
which has brought most gratifying results, which could be
employed by every Catholic hospital in the country and
would place your medical colleges in the front ranks. The
system consists in assigning one or more medical students
for service in the hospital to each regular intern to assist
in every detail of his work, with no responsibility except
to obey orders, the intern taking the entire responsibility.
The extern gives his entire time to this work for three
or four, six, or eight months, according to the division of
the school year into quarters or semesters, or, according
to the plan just introduced, quadrumesters. This service
should be taken between the second and third school year
and again between the third and fourth.
Students who have taken this work in our hospitals in
the past have invariably become leaders in the profession
because of their intimate contact with the patient and the
medical staff before completing their college work.
We have a weekly conference for all interns and externs,
which adds to their enthusiasm as well as to their under-
standing.
Many important details cannot be discussed here, but
the opportunity is before you and should not be wasted.
No one is useless in the world who lightens the burden
of it for someone else. — Charles Dickens.
126
THE MODERN HOSPITAL
BULLETIN OF THE
AMERICAN
HOSPITAL ASSOCIATION
^^i^am^
Monthly Bulletin issued from the Executive Offices
7iS Seventeenth Street. N. W.. Washington. D. C.
HOWELL WRIGHT. Executive Secretary.
APPOINTMENT OF TEMPORARY EXECUTIVE
An Open Letter From the President of the American
Hospital Association to the Members
To the Members of the American Hospital Association:
Hospital war problems will be the keynote of the meet-
ing of the American Hospital Association in Atlantic City,
September 24-28, 1918. If well attended and successful
it will be the most important meeting the association has
ever held. Hospitals are facing more vital problems today
than ever before — problems which can be settled, adjusted,
or met only by unified, concerted action, problems far-
reaching and many sided, resulting directly from the war,
which can be understood only through extended discussion
and by aid of those in authority who can give funda-
mental facts and reasons. It is the public duty of the
hospitals of America to take part in this meeting and
thereby contribute to its success. No hospital can afford
to be without representation. It is the obvious duty of
the trustees of every hospital to arrange for the attend-
ance of a representative.
Our secretary. Dr. William H. Walsh, who for some time
has been in the Surgeon General's office, was, in May,
ordered to Camp Grant to assemble and become the com-
manding officer of Base Hospital No. 58. General plans
for the commercial exhibit and for the program had been
worked out, but there remained much work to make them
accomplished facts. A temporary executive was, there-
fore imperative.
On June 12 the trustees of the association met in Wash-
ington at the call of the president to consider the situation.
Dr. Walsh was given indefinite leave of absence without
pay. The president and the first vice-president were
authorized to present the situation to the Cleveland Hos-
pital Council and, if possible, secure the part-time services
of Mr. Howell Wright, its executive secretary. Recogniz-
ing the importance of the situation to the American Hos-
pital Association, the Cleveland Hospital Council con-
sented to give up the services of Mr. Wright to such an
extent as is necessary to carry on the essential work of
the association. The formal letters arranging this cooper-
ation with the Cleveland Hospital Council follow this
communication and are commended to your attention.
In recognition of the often repeated suggestion that the
American Hospital Association should be an association
of hospitals, with hospital or institutional membership as
well as individual membership, the trustees authorized the
appointment of a special committee to give consideration
to this subject and report its recommendations at the
convention. The personnel of this committee as appointed
by the president is: chairman, Dr. A. R. Warner, super-
intendent Lakeside Hospital, Cleveland; Mr. Michael M.
Davis, Jr., director Boston Dispensary, Boston; Mr. Rich-
ard P. Borden, trustee. Union Memorial Hospital, Fall
River, Mass. The report of this committee will be printed
and published prior to the convention, and copies sent to
all the members for consideration and study. The recom-
mendations of this committee should have an important
bearing upon the future development of the association.
The hospital problems of today are not alone individual
problems. They are the hospital and health problems of
the nation at war. They require discussion and deliber-
ation. They demand concerted action for adjustment and
solution. They constitute the basis of the program of the
meeting. The president appeals to the members of the
association to join in this opportunity for patriotic service.
Arthur B. Ancker,
President American Hospital Association.
June 13, 1918.
Mr. Howell Wright, Executive Secretary, Cleveland Hospital Council,
Cleveland.
Dear Sir : As president of the association, I have been authorized by
the trustees to complete arrangements with you whereby you shall
become the executive secretai-y of the American Hospital Association
temporarily if the Cleveland Hospital Council shall consent to this
arrangement. It is needless to discuss at this time the need of the
Association for an executive secretary to carry out the plans and
arrangements for the forthcoming meeting. These plans in general are
determined. We desire an executive to accomplish them. Realizing the
difficulties in combining this work with your present responsibilities,
you are hereby assured that you will have the cooperation and support
of myself and the tinistees and there will be no disposition to make your
work difficult by unnecessary instructions or interference of any kind.
You will be the accredited executive officer of the association with all
the privileges and responsibilities which usually accompany executive-
positions. We will ask results only.
In consideration of the above services the American Hospital Asso-
ciation will pay you $100 per month for the time you serve it and also
allow you all necessary personal expenses incurred by you in carrying
out this work.
Youi-s vei-y truly,
Arthur B. Ancker,
President American Hospital Association.
June IB, 1918.
Dr. Arthur B. Ancker, President American Hospital Association,
St. Paul. Minn.
My dear Dr. Ancker : I have given most careful consideration to
your letter of June 13. Although the Cleveland Hospital Council has
consented to loan my services to the American Hospital Association
temporarily in the capacity of executive secretary, I personally have
hesitated to give my consent to the arrangement.
My ambition is to be in a position to perfonn some service of real
value in connection with the war. I have had some slight opportunity
for such service as secretary of the Cleveland Hospital Council. There
is no present indication that my acceptance of the position of executive
secretary of the American Hospital Association will afford any added
personal opportunity for war service. I hope, however, that the
immediate future will develop other conditions which will present to
the association and to me personally opportunities to contribute more
extensively to such service.
Among other important plans and policies, the Cleveland Hospital
Council is committed to the proper development of its new purchasing
bureau and to a very definitely worked out legislative program. This
latter includes my candidacy for nomination and reelection to the Ohio
Senate. I must do my part in carrying out this and the other policies
of the council.
The chief work apparently expected of me, as suggested in your
letter, is to complete plans and arrangements for the forthcoming con-
vention at Atlantic City. If I were entirely free to do this work only,
it would not be particularly difficult but added to all the rest of my
work it will be considerable of an added strain in that it will require
traveling and the transaction of business from Cleveland through the
office of the association now located in Washington. However, for a
period of a few months I will endeavor to handle this situation in this
way, if necessary.
Although the indication is that there will be no added personal
opportunity for real war service work in my taking on this new posi-
tion, I would not for a moment think of accepting the responsibility if
I thought I would not be in a position to be helpful in any plans for
THE MODERN HOSPITAL
127
/^/A^
^///'^r-
re
fo:'
^1-
^1-
f"
"^\
?•■-•
9ef
ff^
1
■"/
/^^V'A'. va/T M/IK.
. £f^CJiCAr£> /hjvt-'
Kerleed plan of exhibit space of the
Ajserican Hospital A66oclatlon Convention
at Atlantic City, Eoyal falace Hotel,
September £4 to 26. 1918.
Make all applications for space on
Inclosed form to Eowell Wright, 726 17th
street, N. W., Washington, D. C, or 308
Anisfleld Btilldlag, Cleveland, Ohio.
Z/ii*W^
Fig. 1. Floor pla
of exhibit space in the commercial exhibit of the An
\rr■'^r^^...
H-" '-'—>
Hospital Association.
nstructions
this spirit
?ase accept
American'*
the present or future development of the association for greater useful-
ness to the country. I shall consider myself to be in such a position.
I note your statement that I am to be "the accredited executive
officer of the association with all the privileges and responsibilities
which usually accompany executive positions" and that "there will be
no dispositoin to make your work difficult with unnect
or interference of any kind." I accept the position 1
and in accordance with the other terms of your letti
my assurances that I w-ill do my best for the success
Hospital Association.
Cordially yours,
Howell Wkight,
Executive Secretary.
Hotel Headquarters and Reservations
The Royal Palace Hotel is headquarters for the conven-
tion. All general sessions and section meetings, as well
as the commercial and non-commercial exhibits, will be
in this hotel. Reservations should be made early and
application for the same should be made to the hotel direct.
Neither the office of the association nor the local committee
are in a position to make reservations. The following
schedule of rates for accommodations, all of ivhieh are on
the American plan only, will apply to delegates to the
convention and their accompanying friends:
Per day
One person in room without private bath... $ 4.00
Two persons in room without private bath . . 8.00
One person in room with private bath 6.00
A few single rooms with private baths at... 5.00
Two persons in room mth private bath.
A weekly rate will be given to any one desiring to
remain a week or longer upon notification. Also, a suite
of two rooms with bath between, twin beds in each room,
for four persons might be had for $18.00, $20.00 and $22.00
per day for the party.
$ 4.50
9.00
7.00
5.00
10.00 11.00 12.00
Within a short time a complete list of other available
hotels in Atlantic City, together with the rates, wnll be
mailed to all of the members of the association; also addi-
tional literature about Atlantic City. The pre-convention
number of The Modern Hospital will contain additional
information about Atlantic City, the "playground of
America." The secretary has conferred with Dr. I. E.
Leonard, chairman of the local committee on arrangements
and Mr. W. F. Hanstein, manager of the Royal Palace Hotel.
Both are enthusiastic about the convention and can be
counted upon to do their part in giving members and guests
a hearty welcome, and to make the convention a success.
The complete membership of the local committee is as
follows :
Chairman: Dr. I. E. Leonard, superintendent. Dr. Leon-
ard's Private Sanitarium, 2842 Atlantic Avenue, Atlantic
City, N. J.; Eugenia D. Ayers, R.N., superintendent, The
Elizabeth General Hospital, Elizabeth, N. J.; George
Bailey, Jr., superintendent. Cooper Hospital, Camden, N. J.;
Mr. S. J. Barnes, financial secretary, Orange Memorial
Hospital, Orange, N. J.; Nelly R. Burby, R.N., superin-
tendent, Training School, The Paterson General Hospital,
Paterson, N. J.; Miss Edith J. L. Clapp, superintendent,
Englewood Hospital Association, Englewood, N. J.; Dr.
S. B. English, superintendent, N. J. Sanatorium for Tuber-
culous Diseases, Glen Gardner, N. J.; Mrs. W. D. Harper,
superintendent, Monmouth Memorial Hospital, Long
Brar-h, N. J.; Miss Macie N. Knapp, superintendent, Over-
look Hospital, Summit, N. J.; Amzi Lake, superintendent,
Masonic Home, Burlington, N. J.; Miss F. Virginia Lude-
kens, superintendent. City Hospital, Atlantic City, N. J.;
Dr. John J. MacDonald, superintendent, City Hospital,
128 THE MODERN HOSPITAL
•WKER LINEN V^"
Fig. 2. Booths in the commercial exhibit.
Jersey City, N. J.; Dr. D. N. Messier, trustee. The Somerset
Hospital, Somerville, N. J.; Miss Bessie L. Millman, R.N.,
superintendent, Orange Memorial Hospital, Orange, N. J.;
Margaret T. MuUer, superintendent, German Hospital,
Jersey City, N. J.; Miss A. C. Murray, Presbyterian Hos-
pital, Newark, N. J.; Miss M. Louise Pugh, superintendent,
Middlesex General Hospital, New Brunswick, N. J.; Dr.
Henry E. Ricketts, superintendent, Essex Co. Hospital
for Contagious Diseases, Belleville, N. J.; David Schwab,
superintendent, Nathan and Miriam Barnert Memorial
Hospital, Paterson, N. J.; John M. Smith, superintendent,
Muhlenburg Hospital, Plainfield, N. J.; Charles E. Talbot,
superintendent, Newark City Hospital, Newark, N. J.
Special Trains and Transportation Rates
The following quotation from a communication under
date of July 5 from the Assistant Director of the Division
of Traffic, United States Railroad Administration, will
answer all inquiries relative to special transportation
rates to the Convention.
*'The Railroad Administration has been besieged by requests of every
character througrhout the country for some special concessions in the
matter of convention fares and, of course, it has been necessary to
uniformly decline these requests. Any concession granted in one case
would have to be extended to all alike, with the final result thpt the
existing order of the director general in regard to passenger fares
would be practically nullified."
The office of the association has deemed it inadvisable
to attempt to make arrangements for special trains. The
secretary has been informed that it is highly improbable
that any such concession will be granted and therefore
advises members of the association to govern themselves
accordingly.
It is possible that special cars may be obtained for
members from various sections providing a sufficient num-
ber of passengers can be guaranteed. For the present all
inquiries relative to special cars should be made of local
railroad officials. Additional information, if any can be
obtained in the meantime, will be published in the pre-
convention number of The Modern Hospital.
Tentative Program Twentieth Annual Convention of the
American Hospital Association, Royal Palace Hotel,
Atlantic City, N. J., September 24-28, 1918.
Only an outline of the program of papers and discus-
sions can be given at this time. Particular attention is
called to the division of the sessions into, first, general
session, second, section meetings. No section meetings
have been held before at a convention of this association.
Owing to the decision to devote Wednesday, September
25, almost entirely to discussion of hospital problems aris-
ing out of the war, it has been necessary to assign some
of the section meetings to days other than those requested
by the various section chairmen. It is probable that more
changes will have to be made but every effort will be
made to make the assignments conform to the requests.
It is planned to publish the complete program in the
pre-convention number of The Modern Hospital.
CONVENTION calendar
Monday. September 23, 1918.
3 p. m. : Registration.
Tuesday, September 24, 1918.
9 a. m. : General session.
2 p. m. ; Section meetings.
1. Out-patient.
2. Dietetics.
3. Social service.
4. Hospital construction.
Evening : Entertainment.
Wednesday, September 2.5, 1918.
9 a. m. : General session.
2 p. m. : General session continued.
8 p. m. : General session.
Thui-sday, September 26, 1918.
ral
2 p.
Sectii
meetings.
THE MODERN HOSPITAL
129
1. Out-patient.
2. Nursing:.
3. Social service.
4. Hospital administration.
Friday. September 27. 1918.
9 a. m. : General session.
2 p. m. : Section meetings.
1. Hospital administi-ation.
2. Dietetics.
3. Hospital construction.
4. Nursing.
8 p. m. : General session.
Saturday. September 28. 1918.
9 a. m. : General session.
Reports of committees and election of officer?.
Adjournment.
TUESDAY, SEPTEMBER 24, 1918
MORNING (9 A. M.) GENERAL SESSION
Invocation —
Address of welcome — ■
Response— Daniel D. Test. Philadelphia.
President's address— Arthur B. Ancker. M.D.. St. Paul.
Report of special committee on Institutional Membership in the asso-
ciation—A. R. Warner. M.D.. Cleveland.
Report of the secretary, including Membership and Publicity Committee
reports.
Announcements — Appointment of Committee on Time and Place.
Inspection of commercial and non-commercial exhibits.
(2 p. M.) SECTION MEETINGS
Section on Out-patient Work— Michael M. Davis. Jr.. Boston, chairman.
Fighting Venereal Disease : A National Program Calling for Dis-
pensary service. Speakers to be arranged in cooperation with the
office of the Surgeon General and of the United States Public
Health Service ; lantern slide illustrations probably to be included.
Section on Dietetics— Lulu Graves. Chicago, chairman.
f Meeting of American Dietetis Association!, program announced
later.
Section on Social Sei'\'ice — John E. Ransom. Chicago, chairman.
Relation of Social Service to the Successful Treatment of Gonorrhea
and Syphilis in Hospitals and Dispensaries, Miss Ida M. Cannon,
Boston. Chief of Social Service — Massachusetts General Hospital.
A Social Worker at the Admission Desk — Janet Thornton, Boston,
Registrar, Boston Dispensary.
WEDNESDAY. SEPTEMBER 25. 1918
MORNING (9 A. M.) GENERAL SESSION
HOSPITAL PROBLEMS RESULTING FROM THE WAR
Report of the War Service Committee — S. S. Goldwater, M.D.. New
York, Chairman.
Papers by representatives of Surgeon General's office, American Red
Cross. War Risk Insurance Bureau, Federal Vocational Board (to
be announced later).
AFTERNOON (2 P. M. )
CONTINUATION OF WAR SER\1CE PROGRAM
"Utilization of Civi' Hospital Facilities— Arthur W. Dunbar. Medical
Director United States Navy.
Other papers to be announced later.
Inspection of exhibits.
Section
Progr
Section
EVENING (8 p. M.) GENERAL SESSION
Nursing — .
1 to be announced later.
TUESDAY. SEPTEMBER 24. 1918
AFTERNOON (2 P, M.)
Hospital Construction — Dr. George O'Hanlon, New York,
fProgram to be announced later.^
Inspection of exhibits.
EVENING
Entertainment by local committee.
THURSDAY, SEPTEMBER 26, 1918
MORNING (9 A. M.) GENERAL SESSION
Report of the Committee on Out-Patient Work — Michael M. Davis, Jr.,
Boston, chairman.
Paper on the development of War Service.
Dispensaries in France under American auspices — By a medical staff
member of the American Red Cross.
Hospital Construction— N. V. Perry. Constructing Engineer U. S.
Public Health Service.
Report of Committee on Legislation- Howell Wright, Cleveland, chair-
man.
AFTERNOON (2 P. M.) SECTION MEETINGS
Section on Out-Patient Work— Michael M. Davis. Jr., Boston, chairman.
Papers and discussions on Raising Money for Dispensaries during the
War : Dealing with Food Problems among Dispensary Patients ;
Industrial Dispensaries as part of a Program for National Ef-
ficiency during the War.
Section on Nursing — .
Program to be announced later.
Section on Social Service— John E. Ransom, Chicago, chairman.
The Aims of Hospital Social Service.
Training for Medical Social Sei-vice.
Problems and Opportunities in Out-Patient Obstetrical Work or the
Problem of the Cardiac.
Section on Hospital Administration— Joseph B. Howland, M.D.. Boston,
Description of Clinical Record System at the Presbyterian Hospital —
Adrian Lambert. M.D., Presbyterian Hospital.
Method of Keeping Payroll at the Barnes Hospital and Peter Bent
Brigham Hospital— L. H. Burlingham. M.D.. superintendent Barnes
Hospital.
Inspection of exhibits.
FRID.\Y. SEPTEMBER 27. 1918.
MORNING (9 A. M.) GENERAL SESSION
Extension of Civil Hospitals for Militai-y Emergencies — A. B. Tipping,
superintendent Touro Infirmary, La.
Discussion.
Report of the Committee on Social Insurance — Thomas Howell. M.D.,
New York, chainnan.
Social Service and Hospital Efficiency — A. R. Warner. M.D., Cleveland.
Discussion.
Report on Standardizatii
Washington, D. C. c
of Hospitals— Winford H.
lith. M.D.,
AFTERNOON (2 P.
Hospital Administrati
M.) SECTION MEETINGS
m — Joseph B. Howland. M.D.,
War Time Economies- T. A. Deva
Peter Bent Brigham Hospital.
Other papei-s to be announced.
M.D., Assistant Superintendent
M.D.. New York.
Section on Dietetics— Lulu Graves. Chicago, chair
Program to be announced.
Section on Hospital Construction — George O'Hanlo
Program to be announced.
Section on Nursing — .
Program to be announced.
Inspection of exhibits.
EVENING (8 p. M.) GENERAL SESSION
Paper on Dietetics.
Meeting of American Dietetic Association.
Rest of program to be
SATURDAY. SEPTEMBER 28. 1918
MORNING (9 A. M.) GENERAL SESSION
Report of the Treasurer — Asa S. Bacon, Chicago.
Report of Auditing Committee — W. E. Woodbury, M.D., New York,
chainnan.
Report, Committee on Accounting — A. R, Warner. M.D., Cleveland,
chairman.
Report of Nominating Committee — Louis R. Baldwin. M.D.. Minne-
apolis, chairman.
ADJOURNMENT
Commercial Exhibit
Members of the association are urgently requested to
interest themselves in the commercial exhibit and the
revised plan for the same. Included in this bulletin will
be found a plan of floor space for the exhibit and an illus-
tration of the exhibit booths which are to be erected.
Members can be helpful in making the commercial exhibit
a success by calling these to the attention of representa-
tives of hospital supply houses from whom they are in
the haoit of buying.
A list of firms who have already engagd space and the
spaces selected by them is also given below. Members are
urged to keep this list at hand and to see the September
130
THE MODERN HOSPITAL
bulletin for additions. Members will be helping the asso-
ciation as well as themselves by patronizing these ex-
hibitors at the convention. There are many advantages
to hospital buyers placing their orders direct with the
manufacturers and dealers who exhibit there. A com-
plete revised plan with special information for commer-
cial exhibitors is printed in this bulletin.
SPACES T.-^KEN TO DATE
J. S. Lippincott & Co *• "^
Prosperity Company ■ • 16
Prosperity Company 16
Becton, Dickinson & Co 23
Har\ey R. Pierce Company 1
Tlie Pf audler Company -
Wilmot Castle Company 39
KatTee-Hag Corporation 43
Kny-Scheerer Corporation 46
Frank S. Betz Company 10, 17
Kimberly-Clark Company 45
Hospital Management 3
The Coast Products Company 32
Read MachineiT Company • • 4
Taylor Instrument Companies 40
H. D. Dougherty & Co 24, 25
F. A. Hall & Sons 6, 7
H. W. Baker Linen Company 11
Lewis Manufacturing Company 2fi
Troy Laundi*y Machinery Company 15
The J. B. Ford Company 14
The Holtzer-Cabot Electric Company 5
Randies Manufacturing Company 41
The Colson Company 18
Albert Pick & Co 27. 28
Health Standards and Care for the Immigrant
In response to the nation-wide demand for better and
more thorough ways of Americanizing the immigrants in
the United States, the Carnegie Corporation has under-
taken a national study of the methods of Americanization
now in use. The work is to be done by ten divisions which
are to conclude the study in a year. The division on health
standards and care will be under the direction of Michael
M. Davis, Jr., director of the Boston Dispensary. The
aim of this particular division is to learn what the health
agencies throughout the United States ai'e doing to teach
the immigrant our American standards of health. A
special effort will be made to study methods which have
been successful in some localities and to develop from
these recommendations for communities having similar
problems. The division earnestly desires the cooperation
of individual physicians, and of hospitals, dispensaries,
health departments, nursing and medical associations. In-
dustries, and all the national organizations working to
promote the public health. Information is sought con-
cerning health conditions and problems among the foreign-
born of different races and localities and concerning meth-
ods of health care and education which various organiza-
tions have found effective among them. It is hoped that
by means of this national survey material can be secured
which may prove helpful to all the many individuals and
groups which are striving to make the immigrant a better
American citizen. It is intended to make a special inquiry
into alleged serious evils due to quack practice among
immigrants. This study of Americanization is one of the
first large undertakings of the Carnegie Corporation,
which, by the way, must not be confused with the Car-
negie Foundation.
HISTORIC MEETING OF THE ORGANIZED MEDICAL
PROFESSION OF THE COUNTRY
Success comes in "Cans!" Failure comes in "Can'ts!"
— Friend's Calendar.
The Si.xty-ninth Annual Session of the American Medical
Association — Patriotism and Reconstruc-
tion the Dominant Notes
The American Medical Association opened its sixty-
ninth annual session at the Auditorium Theater in Chicago
on the evening of June 11. The stirring music of the Fort
Riley band sounded at the outset the patriotic tone of the
whole conference. There were many scientific and clinical
papers of great value at the sectional meetings during the
week, and eight thousand and more men of the association
attended the meeting this year. The outstanding features,
however, which will live in the memories of many who
attended as long as memory shall last, were the great
patriotic demonstrations of the evening meetings and the
papers and pictures on the reconstruction of the disabled
soldier.
The opening meeting was called to order by the president
of the association, Dr. Charles H. Mayo of Rochester,
Minn,, and welcoming addresses were made to the delegates
and membei's by the presidents of the Illinois and Chicago
medical societies. The uniformed officers of the medical
reserves of the army and navy marched in military file to
their seats on the stage to the music of the Fort Riley
band and the cheers of the audience.
Governor Fi-ank O. Lowden of Illinois gave a most
stirring address on the necessity for each individual's
sacrificing his personal interests to the winning of the war,
and told of the splendid way in which the medical men of
this country had responded to the call to the colors.
The representatives of Great Britain, Canada, France,
and Belgium were introduced and received a royal welcome
from the great audience, which stood up and applauded
and cheered for each of them,
Dr, Mayo introduced Dr, Arthur Dean Bevan of Chicago,
the next president, and Dr. Bevan's address, filled with
the most intense patriotism and pledging the service of the
medical profession of America, closed this meeting.
The section sessions on Wednesday, Thursday, and Friday
were devoted to clinical papers and discussions of the
sections on practice of medicine, surgery, ophthalmology,
pediatrics, pathology, dermatology, stomatology, nervous
and mental diseases, genito-urinary diseases, gastro-
enterology, and orthopedics.
The medical military meeting was held at the Medinah
Temple on Wednesday evening. This meeting will go
down in the annals of the American Medical Association
as historic. The Medinah Temple has large seating
capacity, but was packed to the doors and beyond them,
and the occasion served to express the thanks of our
allies to us and their faith in what America will do in
the winning of the war.
The Fort Riley band, the American Choral Society, and
THE MODERN HOSPITAL
131
the voices of the audience made the rafters ring with our
national songs and in tribute to the allied representatives
joined in "God Save the King," the Marseillaise, and the
Brabanconne.
After a brief speech by Dr. Bevan, the president of the
association, Surgeon-General William C. Gorgas, U. S.
Army, made the opening address. The demonstration at
this meeting and whenever General Gorgas appeared at
the other meetings of the association could leave no doubt
as to the affection and support he has earned from the
medical profession of this country.
Sir James McKenzie and Sir Arbuthnot Lane, the British
representatives, men whose word is law unto the profes-
sion of medicine and surgery, were received wath en-
thusiasm, and both gave splendid addresses in which they
told of the growth of the British medical organization dur-
ing the war.
M. Justin Godart, formerly undersecretary of state for
the French military medical department, addressed the
meeting in French, but with such clear enunciation and
spirit that even those of the audience who could not under-
stand the French wording of his speech were aroused to
enthusiasm. Major Edouard Rist's address was made in
most accurate English without even trace of accent.
Major Rist made an apt comparison of the growth of
German ideas and ruthless methods to gain world do-
minion, to the insidious inroads of a malignant growth
in the human body. He said, "For cancer there is only
one remedy, the knife, and the work must be done so
thoroughly that there shall be no recurrence."
Dr. Rene Sand of Belgium was received with the greatest
enthusiasm by the audience. Captain Sand's address was
short, simple, and direct. "There are no words," he said,
"which can express the gratitude of Belgium to America.
You have kept us alive with food and clothing and more
than that, have given us courage to live because you cared
for us. The love of Belgium for America will last forever."
Admiral William C. Braisted, Surgeon-General of the
Navy, expressed his enthusiasm for the men of the Great
Lakes Training Station, and his belief in our ultimate
victory which shows in the faces of the 30,000 jackies
out there.
President Ray Lyman Wilbur of Leland Stanford Uni-
versity, addressed the meeting for the Food Administration
and Major Alexander Lambert, M. R. C, told of the
American Red Cross work in France.
All day Thursday at the Auditorium Theater was given
over to the subject of reconstruction. To these meetings
the general public were invited. It is the purpose of the
government and the office of the Surgeon-General to pre-
pare the public mind for this work which will have to be
done and to gain their intelligent cooperation.
At the morning meeting. General Gorgas, Lieut. -Col.
Frank Billings, Lieut. Casey Wood and others explained
something of the purpose of the government in the build-
ing of reconstruction hospitals and the reclaiming and
reeducation of war cripples.
The afternoon meeting was devoted to reconstruction
and vocational education. Mr. F. B. Kidner of the Depart-
ment of Soldiers Civil Reestablishment in Canada told of
the work done in placement and occupations for the
disabled there.
Mr. Douglas McMurtrie of the Red Cross Institute for
Crippled and Disabled Men of New York City, who has
been on the other side studying the methods used by the
allies in reconstruction, illustrated his talk with moving
pictures showing the school and workshops at Montpellier,
France, where great numbers of the disabled from the
French army are fitted with various prosthetic appliances
and taught to walk and to work again.
The following officers of the American Medical Associa-
tion were elected for the coming year: president-elect,
Alexander Lambert, New York City; first vice president,
William M. Wishard, Indianapolis, Ind.; second vice-presi-
dent, E. Starr Judd, Rochester, Minn.; third vice-president,
C. W. Richardson, Washington, D. C; fourth vice-presi-
dent, John M. Baldy, Philadelphia, Penn.; secretary, Alex-
ander R. Craig, Chicago; treasurer, William Allen Pusey,
Chicago.
HOSPITAL ADMINISTRATION FROM THE MEDICAL
POINT OF VIEW
The Massachusetts Medical Society at Its One Hundred
and Thirty-Seventh Annual Meeting Discusses
Hospital Standardization
The exercises of the one hundred and thirty-seventh an-
niversary of the Massachusetts Medical Society were held
on June 18 and 19, 1918. Of especial interest to hospital
executives were the afternoon sessions. The June 18 after-
noon session was devoted to a symposium on the Massa-
chusetts Plan for Caring for Consumptives, with Dr.
Walter G. Phippen, of Salem, Mass., in the chair, and
Dr. John B. Hawes, 2nd, of Boston, acting secretary. The
afternoon session of the 19th was devoted to the question
of hospital administration. Dr. Homer Gage, of Worces-
ter, acted as chairman, and Dr. Channing C. Simmons, of
Boston, as secretary.
In the symposium on the Massachusetts Plan for Car-
ing for Consumptives, Dr. Arthur K. Stone, of Framing-
ham Centre, chairman of the Board of Trustees of the
Massachusetts Hospital for Consumptives, read a paper
on "The State Tuberculosis Sanatoria and What They
Aim to Do." The purpose of the state tuberculosis sana-
toriums, he said, was to recover health by curing, and to
stimulate effort to overcome preventable disease. During
recent years Massachusetts has had four commissions at
work, studying the problem of tuberculosis within the
state, and as a result various sanatoriums have been
built. The state now has 1,065 beds. The sanatoriums,
however, instead of devoting themselves to their legitimate
purpose, namely, the curing of curable tuberculosis cases,
are forced to accept cases that need to be segregated for
the protection of the public; for instance, at the North
Reading Sanatorium there are nearly one hundred bed
cases which should be in hospitals. Dr. Stone contended
that it was perfectly safe for most of the patients dis-
charged from the sanatoriums to spend eight or nine
hours in ordinary work in the mills. It was the way in
which patients spent the remaining sixteen hours of the
twenty-four that made the difference between health and
sickness. He contended that the sick should be taken care
of near their homes, and that municipal and county insti-
tutions should be reserved for the care of advanced cases.
Closer cooperation could be effected between the state
sanatoriums and the county and municipal hospitals
through conference. He felt that the dispensary system
should be especially developed to supervise discharged
cases and arrange for their readmission when necessary.
Dr. Olin F. Pettingill, superintendent of the Essex
County Sanatorium, read a paper on "County Tubercu-
losis Hospitals." The county tuberculosis hospitals at
present provide beds for curable cases and also take care
of advanced cases. The two classes, in Dr. Pettingill's
judgment, should not be treated in the same institution.
He felt that the county sanatoriums should be centers for
132
THE MODERN HOSPITAL
advice and diagnosis, and that all patients should be ad-
mitted with the privilege of transfer.
Dr. Edwin A. Locke, chief of staff of the Boston Con-
sumptives Hospital, read a paper on "Local Municipal
Tuberculosis Hospitals." Most patients suffering from
tuberculosis, he said, have been infected in early life by
direct contact. The keynote of all tuberculosis work,
therefore, should be prophylaxis. In the campaign against
the disease, state and federal governments should exer-
cise a supervisory function, while the direct attack should
be left to the individual communities. Preventive meas-
ures should especially aim to avoid infection to childhood,
since implantation usually takes place during that period.
These measures should aim to increase the resistance of
the child and to segregate the active cases. The institu-
tional care of advanced cases was, in his judgment, the
outstanding factor of treatment. Many patients should be
sent to sanatoriums, although some might remain in their
homes under the supervision of tuberculosis dispensaries.
The incorrigible, however, should be segregated, and insti-
tutional care should be provided for the destitute tuber-
culous. Sanatoriums should be accessible to the patients
and should suggest the hope of cure by being free from
advanced cases. Dr. Locke devoted the latter part of his
paper to a discussion of the size, cost, and type of building,
and equipment of municipal hospitals.
In his paper on "The Dispensary System of Follow-up
Work," Dr. John F. Hitchcock, Northampton, director of
the division of communicable diseases. State Department
of Health, divided tuberculosis patients into three groups:
(1) open cases; (2) incipient cases; (3) exposed but not
yet infected cases. The latter two are not a danger to
the public. The first group should be cared for in hos-
pitals; the second in sanatoriums; and the third in dispen-
saries. Last year, he said, there were fifty-three dispen-
saries in Massachusetts, employing one hundred and two
physicians, sixty-four nurses on full time and thirty on
part time, as well as six social workers. The dispensaries
had been in touch with 21,689 persons, or 409 to each dis-
pensary. Of this number 55 percent were tuberculous,
or suspected of tuberculosis, while 45 percent were not
tuberculous.
In the session on hospital standardization Dr. John T.
Bottomley, Boston, read a paper on "Hospital Stand-
ardization— What It Means." Dr. Bottomley felt confi-
dent that the cooperation of the hospitals could be
secured in the present movement for hospital standard-
ization, if the motives of the American College of Sur-
geons in seeking standardization were thoroughly under-
stood. Since patients in hospitals have a right to efficient
treatment, the primary purpose of standardization was
the patient's wellbeing. Other desiderata may follow,
but this is primary. Every hospital should be so manned,
equipped, and administered as to bring the highest possible
percentage of the best medical skill in each community to
the needs of the patients. To Dr. Bottomley, the stand-
ards of hospitals means the standards of the medical pro-
fession serving them, and any reform in hospital practice
must come from the physicians and surgeons themselves.
He pointed out that the process of standardization must be
a gradual one, in which ho.spitals that are doing bad work
must be helped to do good work, and hospitals that are do-
ing good work must be urged to do even better work. The
requirements will be placed low at the beginning in order
to enable hospitals generally to secure a rating of at least
90 percent with reasonable diligence. Among the essen-
tial requirements are (1) a sufficient record of the patient;
(2) sufficient laboratory space and equipment for ordi-
nary examinations; (3) establishment of some supervi-
sion over the medical work in the hospital, as, for example,
through a small committee of staff members.
In discussing the method by which standardization
would be brought about. Dr. Bottomley said that a
representative of the American College of Surgeons
would visit the board of trustees of each hospital and
make an inspection of the hospital in a kindly, friendly,
tolerant way and later submit suggestions and recom-
mendations looking to the improvement of plant, equip-
ment, or service. Six or eight months later another visit
would be paid to see whether the suggestions and recom-
mendations had been carried out. Hospitals, as the result
of these examinations, were not to be classified as A, B,
C, etc., but would be known as meeting or not meeting the
standards established.
In discussing this paper. Dr. Huff, of the New Bedford
Hospital, New Bedford, Mass., stated that it was almost
impossible to get interns to keep proper records and that
they could not be compelled to do so. He felt, however,
that if the chief of the service inspected records, they
would be kept better.
"The Administration of a Military Base Hospital and
Its Comparison with a Civil Hospital" was the subject
of an address by Lieutenant-Colonel Channing Frothing-
ham, M.C., N.A. A base hospital must be prepared to
take care of any kind of medical or surgical case (except,
of course, women's and children's diseases and chronic
ailments) and the best treatment must be furnished, as
the patients cannot be sent elsewhere.
The medical department provides the hospital and its
officers. Light, heat, and water are furnished the com-
manding officer by the ordnance department. Supplies
come from three sources : the medical department, the
quartermaster's department, and the ordnance depart-
ment.
The officers are divided into two main groups: those
who need medical instruction and those who do not. The
sanitary corps, for example, contains many men who are
not medical workers, but who do executive work and thus
liberate medical men for purely medical work. The ad-
jutant, who is the commanding officer's private secretary,
need not be a medical man. The registrar is the librarian
and takes charge of the records of the patients. One
officer sees to the feeding of the patients and enlisted men.
The medical property officer by requisition gets property
for the chiefs of the various departments. The chaplain
arranges for the religious services and provides for the
social welfare of the men. The officer of the day serves
for twenty-four hours as personal representative of the
hospital and has charge of the guard.
The professional staff is divided into three main divi-
sions— medical, surgical, and laboratory, the chiefs of
which form a council or "board of strategy." The special-
ties are bj-ought together under the chiefs and in many
instances there are assistant chiefs of service. The ward
physicians and surgeons take the histories of the patients,
prescribe, and have general charge of the patients in the
wards. The receiving officer is held responsible for the
i-eeeption and discharge of patients. The sanitary officer
acts as sanitary inspector and sees that the buildings and
grounds are kept in good sanitary condition. The conval-
escent officer has charge of the patients who are well
along toward recovery and looks after them until they
are ready to go back into service.
Colonel Frothingham expressed the need of a training
school for military nurses, and announced that one was
THE MODERN HOSPITAL
133
to be established shortly at Camp Devans, where he
is stationed, and at several other camps.
Thing's get done more readily in the base hospital than
in the civil hospital. The officer has but to command and
the command is obeyed forthwith. Little money is seen,
as everything' but food is secured on requisition. The
ration money is the only money which comes over the
desk.
The men on service in the base hospital are whole-time
men. It is thus possible to concentrate a group of medi-
cal men on a single case at any time for diagnosis and
treatment. While serving in a base hospital you may be
forgiven for lack of judgment but not for failure to use
the opportunities which the hospital affords. The base
hospital gives the medical men the opportunity to follow
up their treatment as long as they want to. Thi.s is espe-
cially desirable in venereal work.
Dr. E. H. Bradford, Boston, read a paper on "The Need
of Systematic Teaching of Hospital Interns." In many
states, Dr. Bradford pointed out, physicians must have a
hospital year before they ai-e allowed to practice. The
American Medical Association has remedied the old pro-
prietary school situation, and a number of the medical
schools now educate their men well, but they lack the
practical training of apprentices. Science has advanced
so rapidly that practical experience cannot be gained in
the medical school. The hospitals have taken advantage
of the condition of the market and forced interns to take
long-term service. Some have even been compelled to wait
six months while they served as clerks in the hospital.
They do not receive an adequate education, because the
hospital authorities use them instead of teaching them.
How is this situation to be remedied? Hospitals must de-
mand of the chiefs of services that they instruct their
interns; boards of trustees must demand that the admin-
istrative heads of the hospital see that interns are in-
structed; medical schools must demand that interns be
instructed in hospitals; and medical societies must demand
that hospitals educate their interns. The education of
the intern is part of the standardization of hospitals. In-
terns must learn by training their own powers of obser-
vation and assuming definite responsibilities. There should
be regular meetings of the staff and interns to discuss
cases.
Dr. Richard M. Smith, Boston, gave an address on "So-
cial Service and Follow-up Work." The changed attitude
on the part of hospitals toward social service work is
becoming increasingly marked. Hospitals are realizing
more and more that they cannot confine their diagnosis to
the patient as he presents himself at the hospital, but
must consider his living and working conditions. The hos-
pital cannot limit itself to purely medical problems, but
must consider the causes of disease and interest itself
in the prevention of disease.
The physician in the hospital cannot make the neces-
sary social investigation and consequently sees the patient
out of his natural environment unless his observations
are supplemented by the knowledge which the social
worker through her study of home and working conditions
brings. The advantage to the patient of the .social worker
is that she makes the relation of the patient to the hos-
pital less rigid.
The success of hospital social service. Dr. Smith pointed
out, depends on accurate medical work, including an ac-
curate diagnosis and a definite line of treatment. Hos-
pital efficiency is decreased if it fails to take into consid-
eration the background of the patient more than if it
lacks certain equipment.
Some of the functions of the hospital social worker are:
to arrange for the discharge of patients from wards to
other institutions; to see that treatment is carried out
exactly as the doctor orders; to see that patients keep
appointments to come into the hospital; and to arrange
for subsequent appointments in the out-patient depart-
ment. The development of social service work should
be with the closest cooperation and supervision of the
medical men and only trained people should undertake the
work as the hospital social .service field must be recog-
nized as a special field requiring careful training and
experience.
In discussing Dr. Smith's paper Mr. Michael M. Davis,
Jr., said that a misconception of the function of social
service work in hospitals on the part of physicians had
interfered with its development. Its function is a medical
one, intended to help maintain medical efficiency. One of
the seemingly great obstacles to the introduction of social
service in many hospitals is its cost, and yet money is
wasted by many hospitals through sheer lack of social
service workers. Mr. Davis felt that in appealing to the
public for funds to support social service work in hos-
pitals, stress should be laid not only on the humanitarian
motive but also on the efficiency motive, since only through
competent social service work can the most efficient medi-
cal service be rendered the community.
RECONSTRUCTION FROM WAR AND FROM
INDUSTRY
The Third Annual Meeting of the American Association of
Industrial Physicians and Surgeons — Plans for
Effectual Cooperation with Government
for Reconstruction
The American Association of Industrial Physicians and
Surgeons met in the Florentin? Room of the Congress
Hotel in Chicago, June 10. The meeting was to consider
industrial conditions and problems brought about by the
war and ways and means by which the members of the
association, men skilled and experienced in emergency
surgery and the health protection of labor, could help to
speed the war and to win the war.
Dr. C. D. Selby of Toledo, Ohio, gave the following
interesting summary of war-time industrial problems:
It has been estimated that it takes the labor of six
and one-half persons to furnish material and supplies for
each fighting man. This will make, in time, approximately
32,000,000 persons in our industrial forces. It has become
a national duty to protect the efficiency of these forces
from the shortage caused by illness or accident in order
to facilitate and speed production. The coordination of
man and woman power to replace shortage, the necessity
of physical examination and health protection for all
employees, betterment of conditions to prevent migratory
labor, and more counsel between employees and representa-
tives of industrial medicine, were well suggested by Dr.
Selby as aid in conservation of labor in war industries.
The suggestion was also made that an industrial service
corps to take the responsibility for the conservation of
industrial man power in making war supplies could give
good service to the government in the present crisis.
Lieut.-Col. Harry E. Mock, who is an assistant director
of reconstruction in the Surgeon-General's Office, read an
interesting paper on the reconstruction of the returned
disabled soldier in the industries, and predicted govern-
ment supervision of industrial health welfare. During the
discussion of this paper some interesting points were
134
THE MODERN HOSPITAL
brought up on the educational value of the Red Cross
nursing service in industrial health conservation, and in
agricultural industry. It was also mentioned in the dis-
cussion that Harvard University was planning to enlarge
its medical school to include a chair of industrial surgery.
Mr. T. B. Kidner, the vocational secretary of the In-
valided Soldiers' Commission of Canada, told how the
Dominion was caring for 30,000 returned men, through
the splendid cooperation of medical men, employers and
vocational educators, and how each man was provided with
something definite to do. The men in Canada are returned
to a place near their homes or the spot from which they
enlisted. Each is first given a vacation to visit relatives
and friends and then returned to the nearest curative shops
for further training in his old trade or occupation if
possible, and if not, in some other which will provide him
with a means of living. When this has gone far enough,
the employment branches in each province provide the
employment. The returned soldier is paid from the time
he enters the curative shop and is free from the worry
of earning enough to maintain his family. Bach returned
soldier is carefully studied to learn his limitations and
his possibilities, and since the Canadian commission has
become more efficient in its management of the reconstruc-
tion problem, a sufficent variety of vocational training is
provided to care for every type of the handicapped. It is
encouraging to report that, according to the statistics
furnished by Mr. Kidner, the percentage of mutilated men
who have suffered major amputations is comparatively
small, and that there are very few blind in proportion to
the number of men involved.
Captain Sand of the Belgian army was introduced as
one from that brave little country which has stood between
us and the Hun for so long and the audience arose with
one impulse to pay tribute to him. Captain Sand told,
without spleen and without raising his voice from the
ordinary narrative tone, of the deportation of 120,000
Belgian men from the industries to work in slavery, of
the seizure of all available raw material, machinery and
funds, and of the mission of seven veterans, of whom he
was one, to learn all that they could here to reconstruct
their country when their barbarous conquerors shall have
been driven out of Belgium.
Lieut-Col. James Bordley's paper on "Reclaiming the
Blind from War and from Industry" was illustrated with
motion pictures, showing the work accomplished with the
blind in various trades.
Dr. Francis D. Patterson, chief of the division of indus-
trial hygiene and engineering of the Department of Labor
and Industry, Pennsylvania, gave something of the plans
in that state to arrange for the cooperation of the indus-
trial plants with the commission in the rehabilitation of
the disabled soldier.
A banquet was given at the hotel in the evening and
Mr. Douglas C. McMurtrie, of the American Red Cross
Institute for Cripples, gave a summary of the reconstruc-
tion work being done abroad. This was illustrated with
moving pictures showing the reeducation of the handi-
capped in France and England.
The following officers of the American Association of
Industrial Physicians and Surgeons were elected for the
coming year: president, Lieut.-Col. Harry E. Mock, assist-
ant director of the division of reconstruction in the office
of the Surgeon-General of the Army; vice-president, Dr.
Thomas E. Crowder, medical director of the Pullman Com-
pany; second vice-president. Dr. Otto P. Geier, medical
director of the Cincinnati Milling Company; secretary and
treasurer, Dr. Francis D. Patterson, chief of the division
of industrial hygiene and engineering. Department of
Labor and Industry of Pennsylvania.
MINNESOTA HOSPITALS HOLD A SUCCESSFUL
MEETING
Interesting and Patriotic Program at First Annual Con-
ference of Minnesota Hospital Association
The first annual conference of the Minnesota Hospital
Association was held in Minneapolis, June 27 and 28.
The association was organized April 20, 1917, upon the
initiative of the Minneapolis Hospital Council, a local
organization of hospital superintendents. The member-
ship had increased during the year from forty-eight to
sixty, representing fifty hospitals in the state.
A program providing for six sessions during the two
days of the meeting had been prepared by the executive
committee, composed of Mr. G. W. Olson, superintendent
of the Swedish Hospital, Minneapolis, president of the
association; Mrs. George G. Eitel, superintendent of the
Eitel Hospital, secretary-treasurer of the association; Miss
Harriett Hartry, superintendent of St. Barnabas Hospital,
Minneapolis; Rev. Henry Hartig, superintendent of St.
Andrews Hospital, Minneapolis; and Dr. S. G. Cobb, sur-
geon-in-chief of Cobb Hospital, St. Paul.
A prayer was offered by Rev. William Meyer, superin-
tendent of the Deaconess Hospital, Faribault. The ad-
dress of welcome on behalf of the city was delivered by
Prof. A. J. Todd, Ph.D., head of the department of soci-
ology of the University of Minnesota, who is also presi-
dent of the Central Council of Social Agencies of the city
of Minneapolis, an organization with which all the hos-
pitals in the city are affiliated.
Mr. Olson, the president of the association, in the course
of his annual address, said:
"Within our own state hospital progress during the past
year may be said to have been normal. New construc-
tion has been merely nominal, however, and has not kept
pace with the need of the increasing population in many
centers. But there will be notable additions to our hos-
pital facilities in the near future. Through private bene-
factions a new large general hospital will soon be built in
St. Paul. The city of Duluth has received a bequest of
$600,000 for the founding of a new general hospital. St.
Mary's Hospital in Minneapolis is completing and will
soon open a new building, the lai'gest in the state devoted
to the care of private patients. Construction of a new
modern building for the Lymanhurst children's annex of
the Minneapolis City Hospital has been begun, but cannot
be completed until the ne.xt legislature has authorized the
city to issue further bonds for the completion of the
structure.
"A few small private hospitals have been discontinued
during the year. Others have been transformed from
private enterprises into community institutions, by trans-
fer of ownership and control from individuals, usually,
physicians, to groups of citizens organized into hospital
associations. "These conversions of the village surgeons'
individual enterprises into community hospitals, with own-
ership and responsibility in the hands of the best citizens
of the town, are good signs of a better understanding of
the functions of the hospital on the part of both profes-
sion and laity throughout the state. It were desirable
if more of the small private so-called hospitals could be
turned into community enterprises, serving all the quali-
fied physicians and the whole public within the county or
whatever unit might be adopted as the community to be
served. The nursing problems of this type of hospital
is the great retarding factor in its development. It is
now much easier for the individual surgeon to conduct a
private hospital of a few beds in a private dwelling, where
the care can be administered by a practical nurse, than
to operate a central hospital open to other physicians and
THE MODERN HOSPITAL
135
to all the people, because in such a plant there must be a
larger number of persons engaged, with a higher standard
of system, organization and discipline. . . .
"Minnesota presents conditions favorable for the develop-
ment of the ideal small community hospital. I believe
it would be possible in this state, through a little effort
on the part of our association, to secure legislation whereby
hospitals could be aided by their respective communities
with appropriations from public funds, eligibility to re-
ceive such aid to be determined by a state hospital inspector
functioning under the state board of health. The hos-
pital could then be made the center of public and private
health activities in the community to which it belongs.
Surely, it should be no more difficult to legalize the ap-
propriation of town funds towai'd the support of a hospital
than to a fire hose company, a town brass band, or a base
ball park and team of players."
In preparing the program, the committee aimed to give
prominence by precedence to "win the war" topic. "Food
Conservation in the Hospital" was presented by Mrs. Beth
B. Titus, chief dietitian of the Minneapolis City Hospital.
Discussion showed unanimous desire that the government
fix the prices of the wheat substitute cereals.
"Wartime Economies in the Hospital" was the subject
of a very instructive talk by Dr. A. B. Ancker, superin-
tendent of the City and County Hospital, St. Paul, and
president of the American Hospital Association, who said:
"Hospitals are exempted from all of the restrictions of
the federal food administration, but there is no valid
reason why they should not observe every one of them.
Hospital officials, nurses, and employees are as capable of
"Hooverizing' as any other class of workers. The same
is true of patients on house diet. Patients on restricted
diet have always been 'Hooverizing.' . . .
"Some years ago I came near accepting the superin-
tendency of an eastern hospital. One of the conditions
1 insisted upon was that no purchases were to be made
without my order or approval. In discussing this question
with the governing board, I found that they had entered
into a contract for the purchase and delivery of five thou-
sand dollars' worth of gauze in one year. In our hospital
in St. Paul we bought five hundred dollars' worth for the
same period for about the same number of patients. I
didn't go East, because I could never stand to see money
squandered that way."
The second session of the conference opened with a
program dealing with the various phases of the nursing
problem in the small, medium-size and larger hospitals
in the state. "The Small Hospital Without a Training
School," was the subject of a paper by Miss Lillie Denning,
R.N., superintendent of the community hospital at Benton.
Miss Georgia H. Riley, R.N., superintendent of the Monte-
video Hospital, read a paper on "Can the Small Hospital
Maintain a Training School?" Miss Louise M. Powell,
R.N., acting superintendent of the University Hospital,
Minneapolis, presented a paper on "The Trainins; of Pupil
Nurses from Affiliated Schools." The papers and the dis-
cussion following emphasized the fact that to train nurses
properly it is necessary to have not only qualified teachers
and pupils, but most important of all, a sufficient variety
of clinical material and adequate teaching equipment. The
first two requisites are not difficult to provide in this state,
where capable instructors and supervisors and a high
grade of student nurses may be obtained by any hospital
ofl'ering reasonable pay and accommodations. The clinical
material and teaching equipment, however, are sadly lack-
ing in many of the small hospitals. Reorganization of
these hospitals on a broader plan, development of com-
munity interest in what is now private enterprise and
making of the small hospital a social and educational
factor would result in support and patronage that would
place the hospital in position to conduct an accredited
training school with affiliation.
The Thursday evening session was devoted to a round-
table discussion of questions touching the details of hos-
pital management. Prof. A. D. Wilson, federal food ad-
ministrator for Minnesota, gave an inspirational talk on
"Food Conservation in Institutions." Dr. Herbert O. Col-
lins, superintendent of the Minneapolis City Hospital, pre-
sided over the round-table conference at which the follow-
ing questions were discussed:
1. Should the training schools in Minnesota adopt immediately the
policy of giving credit, by shortening the three-year course', to college
graduates ?
2. Would it be good business practice to separate the training school
from the hospital as far as accounting and cost of maintenance is con-
cerned ? Would the result of such separation provide the answer to the
oft-repeated charge that the hospitals are getting the nursing done for
little or nothing?
3. Is the present method of taking the patient census, to arrive at
the daliy average number of patients, as prescribed by the Minnesota
State Board of Examinei-s of Nurses, the correct one?
4. What are the advantages of a central linen room in the hospital
and what is the best plan of operation?
.5. What is the simplest, most efficient and economical way to dis-
infect a room after an infected case?
6. How can the hospital protect itself against losses on workmen's
compensation cases whex*e the hospital charges exceed the statutory
allowance ?
7. what is the best method of collecting delinquent hospital bills ?
5. What is the remedy for the present shortage and high prices of
hospital linens, blankets and bedding?
A paper on "The Design and Construction of the Smaller
Sanatorium and Hospital" was read by Mr. E. H. Sund,
architect, Minneapolis, who has designed a number of
small surgical hospitals and several of the state-county
tuberculosis sanatoriums built recently. In the discussion
Dr. H. O. Collins brought out the fact that, with all the
excellence of design and construction put into the modern
hospital, whether small or large, the builders too often
forget to provide accommodations for those who must
carry on the work in these institutions and who must
necessarily live with their work day in and day out in
order to maintain satisfactory service to the sick. Dr.
Robinson Bosworth, St. Paul, executive secretary of the
Advisory Commission for Tuberculosis Sanatoi-ia in the
state, said that the building of modern sanatoriums had
resulted in a greater number of consumptives submitting
to sanatorium treatment than ever before and for a longer
period of time, and that a reduction in the death rate from
tuberculosis within the state could already be traced to
the operation of these sanatoriums. Dr. Bosworth's ad-
dress was discussed by Dr. E. S. Mariette, resident physic-
ian at Glen Lake Sanatorium, Hennepin County, and Dr.
Conroy, of the Nopeming Sanatorium, St. Louis County.
"The Value of Standardization of Hospitals in Smaller
Communities in Minnesota" was the subject of an address
by Dr. J. W. Andrews, Mankato, which was discussed bj
Dr. Arthur T. Mann, associate professor of surgery at the
University of Minnesota. "Hospital Business Record-
Keeping" was discussed in a paper by Mr. J. E. Haugen,
superintendent of the St. Paul General Hospital, who out-
lined a system in use in his institution which had proved
satisfactory as to the amount and variety of detail neces-
sary and desirable in hospital accounting and yet been
found economical in operation.
On Friday afternoon a paper on "The Hospitals and the
Law — Extent of Privileges and Protection Granted to Gen-
eral Hospitals by the Laws of Minnesota" was read by
Mr. George S. Grimes, attorney and member of the board
of trustees of St. Barnabas Hospital, Minneapolis, who
through years of experience as a hospital trustee had be-
come familiar with the legal phases of hospital work and
worked out solutions of many knotty problems. The final
136
THE MODERN HOSPITAL
paper of the comprehensive program was on "Mechanical
Equipment and Fuel Economies," by Mr. R. B. Whitacre,
St. Paul, an old experienced power-plant engineer. This
paper brought out in detail many points relating to heat-
ing, ventilation, steam and hot-water production, etc.,
which are too often not given due consideration until
mistakes have been made that require costly alterations.
All present were invited to join in an automobile tour
about the city. Automobiles had been provided gratuit-
ously through a committee of the Minneapolis Hospital
Council, headed by Miss Bertha Matlick, superintendent
of Hill Crest Hospital. The tour provided a view of prac-
tically every hospital in the city, gave opportunity for
inspection of the new building of St. Mary's Hospital, and
ended with a delicious picnic lunch served by dietitians of
Minneapolis hospitals at the chai-ming summer home of
Miss Harriett Hartry, superintendent of St. Barnabas
Hospital.
The following officers of the association were elected for
the ensuing year: president, Dr. Herbert O. Collins, City
Hospital, Minneapolis; first vice-president. Dr. E. S. Mari-
ette. Glen Lake Sanatorium; second vice-president, Mr.
Fred Paulson, Norwegian Lutheran Deaconess Hospital,
Minneapolis; third vice-president, Mrs. Sarah H. Knight,
Asbury Hospital, Minneapolis; secretary-treasurer. Miss
Lydia H. Keller, secretary of the State Board of Exam-
iners of Nurses, St. Paul; members of executive com-
mittee, Dr. A. T. Laird, Nopeming Sanatorium, Duluth;
Miss A. Jeanette Christianson, Northwestern Hospital,
Minneapolis; Miss Louise M. Powell, University Hospital,
Minneapolis.
FIRST CONVENTION OF HOSPITALS OF BRITISH
COLUMBIA
Successful Meeting Held and Interesting Program Pre-
sented at Meeting in Vancouver
The first convention of hospitals ever called together
in the province of British Columbia was held at Vancouver,
June 26-28, 1918. It was planned for the benefit of every
person connected directly with or interested in hospital
work of any kind, no matter how small or how large
the institution represented. After prayer by Major the
Rev. C. C. Owen, address of welcome by his worship
Mayor Gale and Dr. C. H. Gatewood, chairman of the
board of directors of Vancouver General Hospital, papers
were read on the following subjects: "Hospital Standard-
ization," by Dr. R. E. McKechnie, F.A.C.S., member of
consulting staff, Vancouver General Hospital; "The Hos-
pital; Past, Present, Future," by Dr. A. S. Munro, member
of the board of directors, Vancouver General Hospital;
"The X-Ray Department," by Dr. W. A. Whitelaw, radio-
grapher to the Vancouver General Hospital; "Problems of
the Hospital in Outlying Districts," by Dr. W. R. Wrinch,
superintendent Hazelton General Hospital; "Small Econo-
mies in Hospitals," by Miss J. F. MacKenzie, R.N., lady
superintendent of the Provincial Jubilee Hospital, Victoria,
B. C; "Hospital Architecture," by Mr. J. A. Benzie, archi-
tect, Vancouver, B. C; "Standardization of Hospital Equip-
ment and Supplies," by Mr. R. B. Leders, purchasing agent
for the Vancouver General Hospital; "The Hospital as a
Community Service," by Dr. H. E. Young, secretary Pro-
vincial Board of Health; "The Elimination of Chronic
Hospital Cases by Proper Dental Diagnosis and Treat-
ment," by Dr. Milton Jones, Vancouver, B. C; "Financing
the Hospital," by Mr. M. L. Grimmett, member of the
board of directors, Merritt Hospital; "Hospital Account-
ing," by Mr. Geo. S. Haddon, managing secretary the
Vancouver General Hospital; "The Hospital Laboiatory,"
by Dr. R. H. Mullin, director of Laboratories, Vancouver
General Hospital; "The Food Problem of Today as It
Affects the Hospital," by Miss G. Sinclair, superintendent
of the Royal Columbian Hospital, New Westminster; "The
Hospital Dietary," by Miss E. Kinney, dietitian to the
Vancouver General Hospital; "The Assistance of Publicity
to the Hospital," by Mr. R. S. Sommerville, member of
the board of directors, Vancouver General Hospital; "Ma-
ternity Work in the Small Hospital," by Dr. W. B. Burnett,
obstetrician to the Vancouver General Hospital; "The
Hospital Pharmacy," by Mr. E. Hall, pharmacist to the
Vancouver General Hospital.
Round-table conferences were conducted by Miss G. N.
Sinclair, superintendent of Royal Columbian Hospital,
New Westminster, B. C, Miss J. F. MacKenzie, superin-
tendent of nurses. Provincial Jubilee Hospital, Victoria,
B. C, Miss K. Campbell, superintendent of Cumberland
Hospital, and Miss M. P. MacMillan, superintendent of
Nanaimo Hospital. The exercises closed with a motor
ride and visit to Royal Columbian Hospital, Westminster,
and provincial mental hospitals, and convocation of nurses
at Vancouver General Hospital. Many of these papers will
appear in future issues of The Modern Hospit.'VL.
Nearly one hundred delegates, representing as many
hospitals, were present, and the keenest enthusiasm was
manifested. Enjoyable entertainments were pi'ovided.
The convention ended with the adoption of constitution
and by-laws and the election of the following officers:
honorary president, Hon. Dr. J. W. McLean ; president.
Dr. M. T. McEachern; first vice-president, Mr. R. S. Day,
Victoria ; second vice-president, Mayor Gray, New West-
minster; secretary, Mrs. M. E. Johnson, Vancouver; treas-
urer. Dr. C. H. Gatewood, Vancouver; executive commit-
tee. Dr. F. X. McPhillips, Vancouver; Miss M. McMillan,
Nanaimo; Charles Graham, Cumberland; Miss L. S. Gray,
Chilliwack; Miss Pitblado, Kamloops; M. L. Grommett,
Merritt; D. G. Stewart, Prince Rupert; Dr. H. C. Wrinch,
Hazelton; Miss B. E. Langley, Fernie; Miss H. Campbell,
Vernon.
Officers of Conference of Tuberculosis Secretaries
At" the Fifth Annual Conference of Tuberculosis Secre-
taries, which was held in conjunction with the Fourteenth
Annual Meeting of the National Tuberculosis Association,
reported in the July issue, p. 46, the following officers were
elected: president, Robert Patterson, Ohio State Tubercu-
losis Association, Columbus, Ohio; vice-president, Ernest
J. Easton, New Jersey Tuberculosis Association, Newark,
N. J. ; secretary and treasurer, Edward Hochhauser, Com-
mittee for the Care of the Jewish Tubercular. Mrs. Sadie
Orr-Bunbar, secretary of the Oregon Association for the
Prevention of Tuberculosis, Portland, Ore., and Mr.
Dwight Breed, secretary of the Texas Anti-Tuberculosis
Association, Austin, Tex., were elected members of the
executive committee.
The Touchstone Magazine, of New York City, has an-
nounced that plans are under way for the establishment
of a convalescent club for soldiers at Lake Worth, near
Palm Beach, Fla. The buildings will include a central
clubhouse, cottages to house from one to six men, and
laboratories; and a dairy and gardens will be maintained
in connection with the colony. Dr. A. Thompson Downs,
of Saratoga, will head the medical staff.
THE MODERN HOSPITAL
137
THE MEMOIRS OF A HEAD NURSE
III. St. Patty of the Hospital by the River— A Gentle
Soul Who Has Kept Her Usefulness and Her
Faith Through Years of Blindness.
One would hardly e.xpect to find a saint, really alive and
sitting straight and brave in an old-fashioned rocking
chair in a little room, but I know of one hospital which
can boast of such a shrine.
Down in an Iowa hospital, where from the windows
you can see a wonderful view of the Mississippi above and
below, Aunt Patty sits in her old-fashioned high-backed
rocker. She knows the river well, has known it for eighty-
three years, but has not seen it for many a day — the
river or anything else — because she has been entirely blind
for a long time. She is crippled as well as blind; she
walks only with the aid of a big stout cane; her hands
are twisted like the roots of a very old tree. No two of
her fingers are parallel, but she makes most of her own
clothes, hems towels and napkins for the hospital, keeps
herself immaculate, her room in perfect order, and never
asks the nurses to do anything for her that she can pos-
sibly do for herself. Every fold of the linen on her bed
is as straight as though it were drawn with a draughts-
man's T and square. In the drawers of her bureau are
even little piles of clothing, handkerchiefs and ribbons
and picture post cards, just where a touch can find them.
The dresses which she wears and which she makes for
herself are always black because she is the last of her
family of twelve brothers and sisters, and it Is part of
Aunt Patty's code of honor always to wear it for them.
How she can make these dresses is a mystery to all of us
who have watched her. They are rnade of black sateen
in winter and of thinner cotton goods in summer. The
waists have high collars and box plaits coming down from
the shoulders, and every plait is accurate and like every
other plait.
I visited Aunt Patty not long ago. When I have told
you something of her philosophy and viewpoint of life, I
think that you will say I am not far wrong in calling her
little room the shrine of a saint. I had known this dear
old lady several years before, and the day before I ar-
rived the nurses had told her that I was coming, so the
room was very tidy and Aunt Patty was waiting. She
sat as usual, straight in her rocking chair, on the wash-
stand beside her the bouquet of sweet peas and mignonette
I had sent from the florists earlier in the day. Sensitive
to changes of atmosphere as all blind people are, she
■ had carried the flowers from one place to another in the
room, as the sun changed, to keep them cool and fresh.
Later she told me that she was going to press some of
them in her Bible.
The superintendent of the hospital had escorted me to
her room, and, as we stood in the doorway, she said, "Here
is someone to see you, Mrs. Hillhouse!"
Aunt Patty stretched out both arms and answered, "I
know who it is."
When I went over to her she drew my head down to
her own and felt my face with her hands, saying again
and again, "Oh, my dear, I knew you would not forget
me, and you look just the same, just the same."
An then. Aunt Patty keeping tight hold of my hand, I
sat down beside her, knowing well that in that half hour
that I had to stay I should surely get courage and comfort
and understanding to take away with me.
"How is it with you?" I asked, and she answered:
"Very well, my dear. The Lord is good. I am not yet
a burden to these good people who are so kind to me. I
am just sitting here and waiting. My nephew, who has
gone to the war and I are the last; all the rest are gone.
Every night when I lay my head on the pillow, I say,
'Lord, thou hast helped me to live through another day;
give me strength for tomorrow, and if it is thy will to
end my time, let me go tonight while I sleep, that I may
not at least be a care to others and a misery to myself,'
and then I sleep well until morning.
"I had a dream the other night. I told it to the minister
and he said it was a beautiful dream and that he would
make a sermon out of it for his congregation. I thought
I was standing on the shore of the sea. Although my eyes
were still blind, I knew that the place was beautiful. Back
of me I could hear the wind in the trees. I knew that
there vv'as sunlight, and not far below me I could hear the
wash of the waves as they broke on the beach. A voice
called me by name, and said, 'On this shore is a wonderful
pearl. If you can find it and hold it in your hand, your
eyes will be opened and you shall see again.'
"I knew that the shore sloped toward the water and that
I must be careful — that if I found the pearl high on the
slope of the sand, it might roll away from me down into
the water. I thought that if I could find my way to the
water first and get on my hands and knees I could grope
my way carefully up the slope as I hunted for the pearl.
"I went down the slope to the water's edge, and getting
on my knees I reached down and there was the pearl un-
der my fingers. Praising the Lord I stood up, holding the
pearl in my hand. My eyes were opened and I saw the sea,
first the white of the surf and then the blue, the light of
the sun on the water and the glory of the sunset — and
there, my dear, my dream ended and I awakened with my
hands hunting for the pearl in the bedclothes.
"And now." Aunt Patty said, "I want to tell you about
my greatnephew. His mother and father are gone and my
people are all gone, and he and I are the only ones of the
generations that are left. He is a young officer in the en-
gineers. A while ago, he was ordered to go to France,
and he was given leave from one of the southern camps
for long enough to come to say goodbye to me. We had
a long talk. It was very hard to have him go, although
I was very proud. I would not have any man of our blood
stand back at this time. When he went away, he stood in
the doorway and called back to me, 'Aunt Patty, when
I come back, I want to see you sitting right in that rock-
ing chair,' and I answered, 'My boy, I shall be here wait-
ing for you.' "
And I believe that she will be.
American soldiers and sailors, and others whose powers
of speech have been impaired, will be given every oppor-
tunity for recovery by the New York Clinic for Speech
Defects. In connection with the clinic are maintained a
medical department to care for the physical condition of
applicants, a dental department, and a ward for the treat-
ment of nervous and mental disorders affecting speech. It
will also teach lip reading to those rendered permanently
deaf and dumb by the war.
How many things, furniture, fixtures, shades, door
knobs, window catches, and odds and ends, are out of or-
der in your hospital — things that can be fixed by a me-
chanic or even by one of the floor men in a few moments?
It is one of the loudest-speaking commentaries on the
aliveness of the superintendent, that one thing of apple-
pie order in the institution.
138
THE MODERN HOSPITAL
Conducted by ANNIE W. GOODRICH, Principal Army School of Nursing.
and CAROLYN E. GRAY. Principal City Hospital School of
Nursing. Blackwdls Island. New York.
Please address items of news and inquiries regarding Department of
Nursing to CAROLYN E. GRAY, Principal City Hospital School of
Nursing, Blackwells Island, New York.
A Plan and the Equipment of a Model Teaching Unit for a
School of Nursing
The rapidly advancing standardization of liospitals, ne-
cessitated by the demands of modern scientific medicine
and surgery, has brought also a demand for better teach-
ing equipment in schools of nursing. In nurses' residences
erected in the past decade are increasingly found diet
kitchens, laboratories, reference libraries, and classrooms
with an equipment for instruction in nursing procedures
that was little dreamed of in the early days of nursing
education.
Many schools, however, are still struggling to obtain
these most important factors in the education of the mem-
bers of a profession in which scientific methods play so
important a part. For their assistance, and as a sugges-
tion for future nurses' residences, thi.T plan for a teaching
department and the equipment for the various rooms is
presented.
The plan, selected as the best of a number submitted,
was drawn by a former student in the department of
nursing and health, Teachers' College, under the direction
of Mr. Van der Bent, lecturer on institution planning. We
are indebted to Miss Lindheimer, superintendent of the
training school of the German Hospital, New York City,
for the list of equipment — an equipment provided for the
new nurses' residence of this institution and the most
comprehensive we have yet seen The list includes equip-
ment for the demonstration room, trays of various kinds,
diet kitchen, laboratory, and reference library.
DEMONSTRATION ROOM EQUIPMENT
FURNITURE
Novocaine.
2 tables.
Adrenaline.
20 chairs.
Ammonia.
1 bureau.
Tui-pentine.
2 enamel tables.
Mustard powder.
1 gas stove (2 burners).
Sweet-oil.
1 utility closet with glass door
s. Zinc oxide and oliv
2 small closets.
Lassar's paste.
1 private patient's bed.
Zinc stearate.
1 ward patient's bed.
Suppositories.
1 crib.
Alcohol, 50 percent
1 waste basket.
Alcohol, 95 percent
1 linen basket
Iodine.
1 screen.
Cantharidal collodio
1 towel rack.
Sinapism.
1 clock.
Flaxseed.
BEDDING
Amylum.
6 feather pillows.
Listerine.
1 hair pillow.
Cantharides.
1 crib pillow.
LINE
4 bath blankets.
16 sheets.
2 typhoid blankets.
12 drawsheets.
2 crib blankets.
24 towels.
2 roof blankets.
6 bolster covers.
2 double blankets.
24 pillow cases.
2 nightingales.
3 shirts.
4 bed-bags.
DRUGS
3 bed-pan covers.
Silver nitrate 1 percent.
6 hot-water bag c
Boric acid 2 percent.
3 ice-bag covers.
bedspreads.
cribspreads.
bath towels.
wash cloths.
dust cloths.
surgeon's aprons.
surgeon's gown.
surgeon's cap.
nurse's cap.
mouth binder.
pair sleeves.
pair lithotomy leggins
pair surgical leggins.
pair knee caps.
laparotomy sheet.
perineal sheet.
pneumonia jackets.
arm slings.
shroud.
INSTRUMENTS
aneurism needle,
scalpel.
artery clamps,
bandage scissoi-s.
needle holder,
tracheotomy tube.
Murphy button,
box assorted needles,
acupuncture needle,
mouth gag.
tongue forceps,
sponge holder,
douche nozzle,
glass catheter,
glass catheter, return
anatomical forceps,
surgical forceps.
Cooper s
straight
grooved dire
probe
EN;*
VARE
SETS
Bladder irrigators.
Rectal irrigators.
Rectal irrigators, return flow.
Turpentine stupe.
Breast stupe.
Rectal feeding.
Lavage.
Gavage.
MISCELLANEOUS
Irrigating tips.
Drinking tubes.
Tongue-depressors.
Safety pins (large and small).
Plain pins.
Sewing needles.
Paper bags.
2 nailbrushes.
2 stopcocks.
Matches.
Toothpicks.
Hypodermoclysis bottle.
Hypodermoclysis needles.
1 Hagner hypodermic stand.
3 silk wax catheters.
1 sterilizing thermometer.
2 Esmarch bandages.
3 tourniquets.
1 sphygmomanometer.
1 cardia dilator.
1 irrigating stand.
1 clotheshorse.
1 Bier's neck bandage.
1 straitjacket.
1 Hooper's restraining sheet and
cket.
1 canva
1 oil-silk 3
1 prematui
pack
ringer
ith
nb.
1 foot tub.
1 hand tub.
1 large basin.
6 medium basins.
6 small basins.
3 gray basins.
1 douche pan.
1 bed-pan and cover,
6 pitchers.
2 pails with covei-s.
2 funnels.
5 instrument trays.
2 pus basins, large.
2 pus basins, small.
5 white enamel spoons.
SPLINTS
2 Buck's— extensions.
1 solid— leg (Volkmann).
1 arm (Volkmann).
1 perforated (Volkmann).
ATOMIZERS, INHALERS,
IRRIGATORS
3 DeVilbiss nasal.
2 DeVilbiss throat.
3 powder insufflators.
3 inhalers.
1 Maws inhaler.
1 croup kettle.
1 rubber bulb irrigator.
1 glass irrigator.
1 Fowler's ear irrigator.
1 nasal irrigator.
ICE-BAG SUPPORTERS
1 adult's ice-bag supporter.
RUBBER GOODS
1 mackintosh.
12 yards rubber sheeting.
3 bed sheets.
2 small rubber sheets.
2 pillow cases of rubber sheeting.
2 aprons.
1 pair rubber gloves.
1 Kelly pad.
1 ice-cap.
1 ear ice-bag.
1 ear and face ice-bag.
1 neck ice-bag.
2 I'ubber rings (large and small)
3 hot-water bags.
1 bath spray.
1 Leiter's coil.
ADHESIVE PLASTER
Adhesive plaster zinc oxide on roll.
Adhesive plaster zinc oxide sterile.
Mole skin.
Laparotomy straps.
BANDAGES
Gauze rollers
P'lannel bandages.
Muslin bandages.
Plaster-of-Paris bandages.
Starch bandages.
Gauze bandages.
1 toothbrush.
1 back rest.
1 Chase doll.
1 doll, five-year size.
Soap.
Sapolio.
Bon-ami.
Green soap.
1 footstool.
Bath sponges.
GAUZE AND COTTON
Non-absorbent cotton
Absorbent cotton.
Cotton balls.
Gauze wipes (large and small).
Gauze tampons (large and small).
Cotton pads.
Gauze packages, compresses.
Fluffs, dressings.
TRAYS
Catheterizing tray.
Thermometer tray.
Cupping tray.
Einhorn tray.
Medicine tray
Feeding tray.
Mouth tray.
Shaving tray.
Eye tray.
Scrub-up tray.
Bath tray.
Baby bath tray.
Physical tray.
Hypodermic tray.
Breast tray.
Simple di-essing tray.
BINDERS
6 straight abdominal binders,
2 straight breast binders.
2 aspirating binders.
2 Scultetus binders.
1 T binder.
1 double T binder.
CLOTHING
2 shirts (male and female).
1 wrapper (female).
1 wrapper (male).
1 pair pajamas.
1 pair stockings.
1 pair socks.
1 pair slippers.
children's and babies' CLOTHING
1 nightgown.
1 bathrobe.
1 pair pajamas.
1 flannel petticoat.
1 dress.
1 suit.
1 pair drawers.
1 pair stockings.
1 pair garters.
1 pair rompers.
1 pair slippers.
1 hair ribbon.
1 bib.
1 gauze diaper.
THE MODERN HOSPITAL
139
140
THE MODERN HOSPITAL
1 birdseye diaper.
2 Ferris waists.
1 nightshirt.
1 petticoat.
1 dress.
1 pair socks.
1 binder.
1 bonnet.
1 pair mittens.
MISCELLANEOUS
1 fracture board.
1 oxygen tank.
1 pair of boards for side of bed.
1 manikin.
3 charts (bone).
2 bed cradles.
2 shock blocks.
1 set of James' bottles.
1 drainage bottle.
1 irrigating can.
1 douche can.
1 Murphy can, with can protec-
tor and hot-water bottle cover
1 oO-ounce solution bottle.
3 solution flasks.
5 glass jars.
1 pitcher for filling hot-water
bottles.
1 instrument sterilizer.
1 electric stove.
1 pasteurizer (Freeman).
* bottle rack.
8 nursing bottles.
2 nipples.
1 Chapin dipper.
1 tablespoon.
1 teaspoon.
1 graduated glass, 16 oz.
1 graduated glass, 250 c. c.
1 graduated glass, 75 c. c.
1 graduated glass. 1 dram.
2 tumblers.
1 bottle brush.
Finger cots.
Vaseline.
2 chart covers.
2 card holders.
1 hernia block.
2 sand-bags.
2 stomach evacuators.
1 rectal dilator.
6 hard rubber tips for nasal
rectal irrigations.
1 Kemp's tube.
Tape.
Thread.
Unbleached muslin.
Flannel.
Rubber tissue.
Rubber tubing.
Connecting tubes.
CATHETERIZATION TRAY
WTiite enamel tray il2V2 by 16).
1 solution basin with cover.
1 small tray.
2 rubber catheters.
2 kidney basins.
1 package towels.
1 package cotton wipes (sterile).
SIMPLE DRESSING TRAY
White enamel tray (IB by 20).
1 instrument tray :
1 anatomical forceps.
1 surgical forceps.
1 Cooper scissors.
1 pointed scissors.
1 gauze scissors.
2 probes ( large and small. ) .
1 grooved director.
4 safety pins (large and small)
sterile.
1 glass syringe.
1 medicine glass
1 medicine spoon.
1 irrigating tip (with 8-inch
rubber tubing).
2 spatulas (wooden).
1 solution basin (sterile).
1 kidney basin.
1 jar balsam Peru tampon.
1 jar boric acid unguent (sterile)
1 jar iodoform packing.
1 jar silver nitrate sticks.
1 pair gloves.
1 package towels.
1 package dressings.
1 package cotton wipes _ (sterile).
1 package one-quarter inch ad-
hesive.
1 package one-half inch adhesive.
4 laparotomy straps.
1 roll two-inch adhesive.
2 gauze bandages.
1 paper bag with safety pin.
1 dressing rubber.
1 bandage scissors.
DRY-CUPPING TRAY
Metal tray (16 by 12). .
8 Cupping glasses (various sizes)
1 alcohol lamp.
1 box matches.
DRY-CUrPING TRAY
Metal tray (16 by 12).
1 bottle alcohol (95 percent).
1 tumbler.
1 metal and glass applicator.
Cotton (absorbent) in small
glass dish.
1 powder shaker.
1 tube vaseline,
1 large towel.
1 small towel.
1 compress.
2 kidney basins.
CONVULSION TRAY
White enamel tray (12 by 9).
1 bottle chloroform.
1 anesthetizing bottle.
1 mask-holder with cover.
1 tube vaseline.
1 sponge forceps.
1 spoon.
1 tongue forceps.
1 mouth gag.
Few small wipes.
MOUTH TRAY
White enamel tray (12 by 9).
1 mouth mug.
1 toothbrush.
1 glass tube with applicators, tooth-
pick swabs, and tongue depress-
1 bottle mouth wash.
1 jar cold cream.
1 jar bicarbonate solution.
1 jar aboline. boric acid, and lemon
juice.
1 kidney basin.
1 towel.
MEDICINE TRAY
White enamel tray (12 by 9).
Medicine glasses.
Medicine spoons
Medicine droppers.
1 glass pitcher.
1 glass rod.
"1 1 medicine list.
THERMOMETER TRAY
White enamel tray (12 by 9).
1 glass tray covered with gauze
compress (filled one-quarter full
with bichloride 1-2500).
Rectal thermometers in tray.
1 glass jar with mouth thermom-
eters, kept in alcohol 95 per-
cent.
1 glass jar with tube vaseline.
1 bottle with alcohol 70 percent.
1 kidney basin.
Absorbent cotton in glass dish.
SHAVINO TRAY
White enamel tray (9 by 7).
1 razor.
1 glass jar with cotton sponges
(with glass dish for cover).
1 bottle green soap.
1 jar with toothpick swabs.
1 towel.
1 roll toilet paper.
HYPODERMIC TRAY
White enamel tray (9 by 7).
White enamel dish (5 by 4) filled
one-half full with carbolic acid
2 percent.
2 glass syringes.
2 glass spoons — kept in solution.
1 medicine dropper.
1 jar with cotton wipes.
1 glass tube with large hypoder-
mic needles.
1 glass tube with small hypoder-
mic needles.
1 glass dish for waste.
I clamp.
FEEDING TRAY
White enamel tray (12 by 9).
1 saucer.
1 feeding cup.
1 glass drinking tube.
1 teaspoon.
1 napkin.
SCRUB-UP TRAY
White enamel tray (16 by 12).
1 bottle ether.
1 bottle alcohol 96 percent.
1 bottle iodine.
1 bottle flexible collodion.
1 alcohol lamp.
1 box matches.
1 medicine spoon.
1 tablespoon.
1 ethyl- chloride spray.
1 gauze bandage (3-inch).
1 Esmarch.
1 tourniquet.
1 kidney basin.
1 dressing-rubber.
1 small specimen jar with lysol.
1 small dressing forceps (kept ir
lysoi solution ) .
1 test tube.
1 package towels.
1 package cotton wipes (sterile)
1 package dressings.
Few glass slides.
PHYSICAL TRAY
White enamel tray (16 by 12).
1 pair examining gloves.
1 tube lubricatum.
1 towel.
1 auscultating cloth.
2 tongue-depressors (wooden).
1 tape measure.
1 kidney basin.
Few plain pins.
EYE TRAY
White enamel tray (16 by 12).
1 small enamel basin for boric acid
2 percent.
1 candle with holder.
1 box matches.
1 kidney basin.
1 eye cup.
1 medicine glass.
1 roll 1-inch adhesive or silk court-
plaster.
1 gauze bandage (2-inch).
1 towel.
1 dressing rubber.
1 bottle boric acid (saturated so-
lution ) .
1 bottle argyrol 5 percent.
1 bottle pilocarpine 2 percent.
1 bottle cocaine hydrochloride 2
percent.
1 bottle homatropine 1 percent.
1 bottle atropine 1 percent.
1 jar white vaseline (sterile).
1 jar bichloride unguent 1-3000.
1 glass tube with eye applicator.
1 glass tube with dropper.
1 package eye dressing (sterile).
1 package eye pads.
1 package eye wipes.
BATH TRAY
White enamel tray (16 by 12).
1 bath towel.
1 face towel.
1 wash cloth.
1 nailbrush.
1 soap dish with soap.
1 comb.
1 mouth mug.
1 toothbrush.
1 talcum powder shaker.
Toothpicks and orange stick.
Mouth wash.
Alcohol 50 percent.
Whisk.
Cotton waste.
BREAST TR-AY
White enamel tray (9 by 12).
1 bottle boric acid 2 percent.
2 bottles alcohol 95 percent.
1 kidney basin.
1 jar toothpick swabs (sterile).
Package wipes.
4 adhesive straps with tapes.
2 tumblers :
One with feeding.
One with saline solution.
Apparatus (placed in tumbler
with feeding).
1 glass syringe (placed in saline
solution).
1 small glass with hot water.
2-inch piece thin rubber tubing.
1 towel.
Litmus paper.
DIET KITCHEN EQUIPMENT
FURNITURE
1 blackboard.
1 china closet.
2 gas stoves with ovens and
broiler.
12 gas stoves.
1 refrigerator.
3 porcelain sinks. .
12 students' marble top tables with
drawers, boards, and closet.
2 tables.
1 desk.
■hairs.
;tools.
BABY BATH TRAY
White enamel tray (16 by 12).
1 rubber apron or piece oilcloth
(with two safety pins).
1 baby bath blanket.
1 bath towel.
1 piece gauze for wash cloth.
1 baby shirt.
1 cord band.
1 diaper (birdseye) with safety-
pin.
1 paper bag.
1 bath thermometer.
1 small enamel dish with sweet oil.
1 small enamel dish with boric
acid solution.
1 talcum-powder shaker.
1 baby hairbrush.
1 scissors.
1 soap-dish with castile soap.
1 jar toothpick swabs.
1 jar cotton (sterile).
1 package with cord dressings.
1 dermatol shaker.
Thimble.
Thread and needle.
Alcohol 95 percent.
EINHORN FEEDING TRAY
White enamel tray (16 by 12).
1 dinner plate.
1 bowl with hot water (bowl
placed on dinner plate).
12
UTENSILS — EQUIPMENT FOR TABLES
12 dishpans.
12 glass measuring cups.
24 white bowls.
12 lemon squeezers.
12 salt shakers.
12 pepper shakers.
12 asbestos mats.
12 spatulas.
12 knives.
12 forks.
12 tablespoons.
12 teaspoons.
12 paring knives.
12 apple corers.
12 soap dishes.
12 handbrushes.
12 asbestos holders.
12 custard cups.
12 muffin rings.
12 small strainers.
5 cake-turners.
7 biscuit-cutters.
2 nutmeg-graters.
8 Dover egg-beaters.
10 wire whisks.
3 flour sifters.
12 double boilers.
12 sauce pots with covers.
12 sauce pots.
12 saute pans.
12 granite plates.
7 coffee pots.
6 granite bowls (two sizes).
6 granite plates (three sizes).
EXTRA EQUIPMENT
Set of dishes for twelve persons.
12 glass dessert dishes.
12 sherbet cups.
12 drinking glasses.
6 egg cups.
2 pickle dishes.
1 gravy bowl.
2 platters (two sizes).
2 vegetable dishes (oval).
1 quart measure.
1 funnel.
3 vegetable pots (large).
2 vegetable pots (medium).
1 vegetable pot (small).
3 large cereal boilers.
1 stock pot.
4 sauce pots (various sizes).
16 tin-covers.
6 small granite frying pans.
1 pair butter paddles.
6 wooden spoons.
8 wooden spoons (split).
^ wire whisks.
small fine strainers,
meat forks,
bread knives.
4 case knives.
7 paring knives.
1 spatula.
3 ice picks.
2 carving knives.
5 basting spoons.
3 can openers.
3 vegetable scrapers.
1 corkscrew.
1 chopping bowl.
2 chopping knives.
1 Chinese strainer.
12 tin covers (large).
24 tin covers (medium).
36 tin covers (small).
1 large white double boiler.
2 pyramid toasters.
1 wire toaster.
1 market basket (large).
1 market basket (small).
13 Japanned trays.
1 granite coffee-pot.
THE MODERN HOSPITAL
141
sranite teapot.
\ mixing boards (thr
I bread boards,
graters.
bread tins.
. cake tins.
sets muffin tins.
iron skillet.
iron griddle.
steamer.
small teakettle.
small double boilers
jelly molds.
potato ricer.
French frying pan.
Dover egg beaters.
cake-turner.
potato-masher.
soup ladle.
nutraeg-grater.
i siiver (nickel) knives.
silver (nickel) forks.
> silver (nickel) tablespo
; silver (nickel) teaspooi
gravy ladle.
soup ladle.
glass sugar bowl.
. glass spoon holder.
custard cups.
bread box.
sugar can.
flour can.
salt can.
yellow bowls (odd sizes
tin measuring cups.
jelly molds (tin).
fancy cooky cutters.
muffin rings.
food chopper,
gram stales (with weig
towel rack.
window pail.
dust brushes,
meat press,
large agate pans,
medium agate pans
small agate pans,
four-quart pails,
two-quart pails,
dripping pans (thri
colanders (two sizej
dishpans (large),
dishpan ( granite ) .
1 vegetable dish (round).
2 cream pitchers.
2 sugar bowls.
2 salt shakers.
2 pepper shakers.
3 glass water pitchers.
3 aluminum trays (three sizes),
18 glass spice jars (three sizes).
1 lemonade shaker.
1 set of yellow bowls (six).
2 two-quart ice cream freezers.
1 ice bag and mallet.
2 rolling pins.
3 jelly cake tins.
2 square cake tins.
1 angel cake tin.
2 butter crocks.
LINEN
6 napkins.
24 dish towels.
12 roller towels.
1 set of three doilies.
MISCELLANEOUS
1 fancy teapot (bowls and crear
pitcher) .
2 earthen teapots.
2 small casseroles.
7 ramekins.
1 chafing dish.
1 glass fruit dish.
LABORATORY EQUIPMENT
CHEMICALS AND DRUGS, ETC.
Ammonium sulphate.
Obermayer's reagent,
Benedict's volumetric solution.
Benedict's qualitative solution.
Sodium hydrate n/lO.
Phenolphthalein.
Diamethylamidoazobenzene ( Top-
pus' solution ) .
I. K. I. solution
F^bach's solution.
Hypobromite solution A.
Hypromite solution B.
Phenolsulphonephthalein ampules.
Aqua ammoniae.
Hydrogen peroxide solution.
Ether.
Oleum terebinthinae.
Alcohol 95 percent.
Solution nitro-prusside.
Acid nitric pure.
Acid acetic 2 percent.
Acid hydrochloric pure.
Solution sodium hydroxide 10 per-
cent.
Acid acetic glacial.
Solution ferric chloride.
Chloroform.
Tincture guaiac.
6 funnels. 12 by % cm.
6 jars. 8 by 5.
3 alcohol lamps, 4-02.
6 funnels, 7 by ^ cm.
1 extra large funnel.
2 cylindei-s, 50 c. c.
2 cylinders, 100 c. c.
2 cylinders, 250 c. c.
4 cylinders, 500 c. c.
2 cylinders. 1000 c. c.
25 bottles, 4-oz.
3 wash bottles, 500 c. c,
6 flasks. 500 c. c.
12 beakers, 50 c. c.
12 beakers, 100 c. c.
12 beakers, 150 c. c.
12 beakers, 250 c. c.
12 beakers, 400 c. c.
12 beakers, 600 c. c.
6 evaporating dishes, size No. 0.
6 evaporating dishes, size No. 2.
6 evaporating dishes, size No. 4.
3 pipettes, 1 c. c.
3 pipettes, 5 c. c.
3 pipettes, 10 c. c.
6 pipettes, 25 c. c.
18 bottles, H' gallon.
7 graduates, 8-oz., 250 c. c.
6 graduates, 1-oz,, 30 c. c.
Large laboratory table, soap-
stone top, for twelve students.
1 microprojection apparatus.
1 microscope, B. and L. D. D. S.
1 hot-air oven, 10 by 10 by 12.
110 volts.
1 Arnold sterilizer (with ther-
mometer) .
1 Freas incubator, 12 by 12 (with
thermometer).
1 urinometer complete set.
180 grams balance.
1 set metric weights, 1 eg. to 100
gm.
1 set apothecary weights.
6 tripods.
6 gauges (brass).
12 test tube clamps.
1 funnel support.
6 supports for twelve tubes.
3 ureometers.
12 urinometers 1000-1040. with cyl-
inder.
4 album inometers.
6 boxes slides (3 gross), medium
3 by 1, domestic.
6 boxes cover glasses (square %) ,
3 gross.
12 Petri dishes. 100 c. 10.
16 sediment glasses, 6 by 1^^ inch.
1 gross test tubes, 6 by % inch.
1 gross test tubes, 6 by 1 inch.
1 gross test tubes, 3 by % inch.
3 jars, 6 by 6.
5 5-pint bottles.
Fehling's solution A.
Fehling's solution B.
Sodium carbonate anhydrous.
Lead acetate.
Pumice stone.
Solution caffeine sodium benzoate
25 percent.
Distilled water.
L| solution eserine salicylate.
h2 solution eserine salicylate.
25 percent ether camphoratum.
20 percent oleum camphoratum.
Solution strychnine sulphate min.
10 containing gr. 1:15,
1 percent solution strychnine sul-
phate.
0.5 percent solution atropine.
1 percent solution atropine.
1:30 solution morphinae Magen-
HYPODERMIC TABLETS
Morphine sulphate, 1 :8 gr.
Morphine sulphate, 1 :4 gr.
Atropine sulphate, 1:150 gr.
Strychnine, sulphate, 1,60 gr.
Nitroglycerine, 1:100 gr.
DigitaUn. pure (Germ), 1.100 gr.
Strychnine sulphate, 1:50 gr.
6 glass rods. 24 by "s inch diam.
6 glass rods, 12 by ^i inch diam.
1 glass rod ( large ) .
1 record syringe, 2 c. c.
1 Luer syringe, 2 c. c.
1 metal syringe, 2 c, c.
1 sub-q-syringe. 2 c. c,
1 measuring glass, 250 c, c.
1 liter glass.
1 tablespoon.
5 outfits for sterilizing syringes
and needles.
12 Bunsen burners, Fletchers with
metal tubing.
6 packages filter paper,
12^;^ cm.
6 packages filter paper.
23 cm.
Absorbent cotton.
WiLsto cotton.
Litmus paper (red and blue).
Matches.
1 soap dish and nailbrush.
1 white enamel pail,
1 stool.
REFERENCE LIBRARY
Surgical Nursing in War Bundy.
Physical Remedies Fox,
The Treatment of Emergencies Owen,
Technique of the Carrel Method Dumas and Carrel,
The Treatment of Infected Wounds Carrel and Dehelly.
Diet Computer Pope.
Standard Dictionary ...'.'.
Illustrated Dictionary of Medicine Gould.
Fatigue and Efficiency Goldmark.
Nursing the Insane Barrus.
Psychotherapy .Muensterberg,
Massage— Its Principles and Technique Boehm and Painter.
The Psychic Treatment of Nervous Dis-
orders Dubois.
Why Worry ? Walton.
Health, Strength, and Happiness Saleeby.
The Influence of the Mind on the Body Dubois.
Psychology and Mental Disease Burr.
Four Epochs of Woman's Life Galbraith.
Surgery and Society Saleeby.
Nervous Children Tucker.
Health Work in the Schools Hoag and Terman.
Social Diagnosis Richmond.
Care of the Mouth and Teeth Kaufman.
Acute Poliomyelitis Draper,
Hospital Management Aiken.
Mouth Hygiene Fones,
The Nation's Health Morris, Sir Malcolm.
Nursing Problems and Obligations Parsons,
Personal Hygiene and Physical Training
for Women Galbraith.
Drugs and the Drug Habit Sainsbury. H.
Treatment of Infantile Paralysis Lovett,
The Sexual Life of the Child Moll.
Plain Facts, 4 vol Kellogg.
Question Manual Kennedy.
Twilight Sleep Hellman.
On Professional Education Allbutt.
Nursing Ethics Robb.
Medical Electricity Abbott,
Human Mechanism Hough and Sedgwick.
State Board Questions and Answers Foote.
State Registration for Nurses Boyd,
Aequanimitas and Other Addresses Osier,
I nvalid Occupation "Tracy.
Medical Essays Holmes.
Self-Help for Nervous Women Mitchell.
The Spirit of Youth and the City Street. . Addams.
The Cost of Living Richards.
The Cost of Cleanliness Richards, E. H,
The Education of Self Du Bois,
Accidents and Emergencies Dulles,
Surgical Nursing Fullerton.
Memoranda on Poisons Tanner,
Bier's Hyperemic Treatment Meyer, Willy.
Preparatory and After Treatment in Op-
erative Case Hanbold.
The Operating Room and the Patient Fowler.
The Operating Room Smith.
Elementary Physiology Huxley.
Materia Medica for Nurses Blumgarten.
Materia Medica for Nurses Dock.
Materia Medica for Nurses Paul.
Lectures on the Action of Medicines Brunton,
Textbook of Physiology Murlin.
Anatomy and Physiology Bundy.
Anatomy and Physiology Kimber.
Physiology of Alimentation Fischer,
Elements of Physiology Hough and Sedgwick.
Dust and Its Dangers Prudden.
Personal Hygiene Pyle.
Hygiene and Morality Dock,
Hygiene for Nurses Mclsaac.
Hygiene of the Nursery Starr,
Hygiene and Sanitation Price, G. M,
Agricultural Bacteriology Conn.
General Bacteriology Jordan.
Pathologie ( German ) Niemeyer.
Practical Hygiene Harrington and Richarson.
Pathogenic Microorganisms Park and Williams.
Elementary Chemistry Bradbury.
The Chemistry of Cooking and Cleaning... Richards and Elliott.
Chemistry for Nurses Ottenberg.
First Course in Chemistry McPherson and Henderson.
Household Chemistry Vulte.
Elements of Physics Henderson and Woodhull.
Bacteria Yeast and Molds Conn.
Bacteria and Protozoa Fox.
Physics and Chemistry for Nurses BlLss and Olive.
The Cost of Food Richards and Horton,
Chemistry of Food and Nutrition Sherman,
Essentials of Dietetics Pope and Carpenter.
How to Cook for the Sick Sachse.
Diet in Tuberculosis Rardswell and Chapman.
Practical Dietetics — Diet in Health and Dis-
ease Pattee,
Food and Cookery for the Sick and Con-
valescent Farmer.
Food Values Locke, E. A.
Dietetics for Nurses Friedenwald Ruhrah.
Food and Dietetics Hutchingson.
A Short Practice of Midwifery for Nurses. Jellett.
The Roller Bandage Hopkins,
Nursing in the Acute Infectioiis Fevers Paul.
Hospital Sketches Peabody, R. S.
142
THE MODERN HOSPITAL
Diet Lists of the Presbyterian Hospital.
New York Carter.
The Delinquent Child and the Home Breckenridee and Abbott.
The Growth of Medicine from the Earliest
Times to About 1800 Buck.
Handicrafts for the Handicapped Hall and Buck.
Obstetrical Quiz Carlson.
How to Know Your Child Scott.
Mental Medicine and Nursing Chase.
The Posture of School Children Bancroft.
Abnormal Children Hollander.
Dental Disease in Its Relation to General
Medicine Colyer.
Care of the Sick Room Cutler.
The Relief of Pain by Mental Suggestion. . Balten.
A Nurse's Handbook of Obstetrics Cooke.
Surgical and Gynecological Nursing Parker and Breckenridge.
Medical Gynecology Kelly.
Reference Handbook of Gynecology for
Nurses McFarlane.
Nursing in Diseases of the Eye, Ear, Nose.
and Throat Manhattan Eye. Ear, Nose,
and Throat Hospital,
The School Nurse Struthers.
Private Duty Nursing DeWitt. K.
Primary Nursing Technique Mclsaac.
Obstetrics and Gynecological Nursing Davis.
The Care and Feeding of Children Holt.
The Care of the Baby Griffith.
Diseases of Children for Nurses McCombs.
Diseases of Infants and Children Chapin, H. D.
Diseases of Infancy and Childhood Holt.
Skin Diseases Meachan, G. N.
Quiz Book for Nurses Pope.
Eye, Ear, Nose, and Throat Nursing Davis and Douglas.
The Junior Nurse Brown. C. A.
Fever Nui-sing Wilco.x. R. W.
Nursing: Its Principles and Practice Robb.
Practical Nursing Ma.xwell and Pope.
Modern Methods in Nursing Sanders.
Under the Red Cross Flag Boardman.
Life of Florence Nightingale Cook, E. T.
Outlines of Nursing History Goodnow.
Life of Clara Barton Epler, P. H.
Life of Florence Nightingale Tooley.
History of Nursing Nutting and Dock.
Modern Treatment — The Management of
Disease with Medicinal and Non-Medici-
nal Remedies Hare, H. A.
A Mind That Found Itself Beers, C. W.
The Unconscious Mind Schofield, A. T.
Tuberculosis — A Preventable and Curable
Disease Knopf.
Social Work in Hospitals Cannon.
Misery and Its Causes Devine.
Public Health Nursing Gardner.
Efficiency and Relief Devine, E. T.
Democracy and Social Ethics Addams.
Twenty Years at Hull House Addams.
Home Economics Parloa, Maria.
Social Service and the Art of Healing Cabot.
Human Mechanism Hough and Sedgwick.
The Other Side of War Wormely, K. P.
Visiting Nursing in the United States Waters.
Internal Medicine for Nurses Farr.
Naturwissenschaf t Ule.
The House on Henry Street Wald, L. D.
Principles of Sanitary Science and Public
Health Sedgwick.
Medical Inspection of Schools Gulick and Ayres.
Orthopedic Surgery Berry, J. McH.
Principles and Practice of Bandaging Davis.
Essentials of Medicine Emerson.
Sources and Modes of Infection Chapin.
Nurse's Handbook of Medicine Hemry.
Diseases of the Skin Jackson.
Manual of the Practice of Medicine Stevens.
Gelenkkrankheiten Bonnet.
Art of Anesthesia Flagg.
The Huntington Memorial Hospital, Boston, will erect
a three-story laboratory building in the near future at
an approximate cost of $60,000. The basement of this
new structure will contain a vault for storing radium
and for experimental work in radio activity, and rooms
for the installation of a highpowered X-ray apparatus.
There will also be a carpenter shop, chemical and clinical
laboratories, and a suite for the use of the resident
physician. On the first floor will be rooms for out-patient
cases, large biophysics laboratories, and rooms for X-ray
and radium treatment. Practically all of the space on the
second floor will be given up to laboratories of pathology
and biology, while the top floor of the building will pro-
vide accommodations for the domestic help of the hospital.
Conducted by MISS LULU GRAVES.
Please address items of news and inquiries regarding Department o€
Dietetics to the editor of this department, in care of THE Modern Hos-
pital, Garland Building, Chicago.
DEHYDRATED VEGETABLES AND FRUITS
One truth discovered is immortal, and entitles its author
to be so; for, like a new substance in nature, it cannot be
destroyed. — Hazlitt.
Economic Value of the Process of Dehydration — Advan-
tages Over Canning
Dehydrated vegetables and fruits have come to stay.
It is to be hoped that the unfounded prejudice against
"dried fruit" has been permanently overcome. There is
much to be said in favor of the improved process of
dehydration, perhaps, but many of the dried fruits and
vegetables which have been on the market in recent years
have deserved more recognition as desirable foods than
they have received. This method of preserving foods has
been given much prominence by the U. S. Food Admin-
istration and others interested in food-saving. Bulletins
are being issued by the department at Washington giving
directions for drying vegetables on a small scale and
describing the necessary equipment.
Community drying plants have been successfully oper-
ated in several places. In these central drying plants tops
of vegetables and parings may be utilized as foods for
stock, and it is conceded that some valuable by-products
may be produced. One in particular has been mentioned —
the making of cream of tartar from potato parings.
The economic value of dried vegetables is especially
deserving of consideration at this time.
First, a perishable food material is changed to a form
which is easily kept, thus eliminating waste due to decay
or other forms of deterioration during marketing and
transportation. It is to be hoped this will help very ma-
terially in a more adequate distribution, so that a shortage
of any vegetable in one locality may be made good from
another part of the country which has an abundance of
this same product. This, too, should help to bring about a
regulation of prices, and the man with the oversupply
finds a market for his crop instead of allowing it to spoil
in the field because there is no market for it at home
and shipping it is apt to result in a loss.
Second, evaporation of the water from fruits and vege-
tables decreases the bulk and weight, thereby relieving
the transportation difficulties very greatly. Their texture
or quality is in no wise injured when compressed into
tight blocks. Tin or wooden containers are unnecessary,
as paper cartons will do, we are told by E. Clemens Horst,
who has done considerable experimenting and investigat-
ing along this line. He further states that one carload
of dried tomatoes equals in quantity thirty carloads of
canned tomatoes. Again, it is said an entire barrel of
spinach may be compressed into a package weighing but
a few pounds. Aside from space and tonnage saved in
transportation of dried vegetables, the saving of tin and
THE MODERN HOSPITAL
143
wood used in cans and boxes would mount to very larpe
figures. Large orders for dehydrated vegetables, such as
potatoes, onions, and carrots, are used by the British army
to a much greater extent than by the American army.
Major Murlin, of the food division of the Surgeon General's
Office, in an address given recently in Philadelphia, spoke
of the advantages offered by these foods in the army, so
no doubt they will be used to as great an extent as they
can be obtained. Major Murlin also called attention to
the amount of time and labor saved in camp by the use
of these vegetables.
These food materials may be made palatable in the
same way that we have been accustomed to preparing
dried fruits — by soaking for several hours and cooking
in the same water in which they were soaked.
Some question has arisen with reference to the loss of
mineral salts, particularly from the green vegetables,
though it is still undecided as to whether or not this may
be a serious matter.
Meeting of American Home Economics .Association
The American Home Economics Association met in Chi-
cago June 2(5-29. With the e.xception of Thursday's pro-
grani, which was given at Hull House, the association
met in Ida Noyes Hall, University of Chicago.
In common with all meetings being held now the
greater part of the program dealt with subjects pertaining
to war-time conditions. Particularly worthy of note was
the talk given Friday morning by Mr. M. D. C. Crawford,
editor of Women's Wear, on American textiles. He con-
tributed a great deal of valuable information about cloth-
ing and materials, and especially about the dye situation.
He laid emphasis upon the fact that colors which can be
guaranteed are to be had, and may be had as easily
and cheaply as at any previous time, but if we wish other
colors than these we must pay the price necessary to
make them.
Sessions were held by the science, institution, and exten-
sion sections which were both helpful and interesting.
Round tables were held, and a visit was made to the
kitchens of the Blackstone Hotel.
Miss Edna White, of Ohio State University, was elected
president for the coming year, and Dr. Langworthy was
elected vice-president.
Experiment in Drying Sweet Corn
Miss Logan, dietitian at the Anna State Hospital, had
success last fall in curing sweet corn by drying it. Coun-
try Gentleman was the corn selected. It was blanched on
the cob for five minutes, then cut from the cob, spread
thin on pans and left in the baker's oven for thirty
minutes at a temperature of 350. From the oven it was
placed on muslin frames and left in a dry, warm attic
for twenty-four hours. The corn has kept and retained
its flavor. This summer the plan is to preserve a large
amount in this manner. It is a much easier and surer
method than canning.
Hospitals Make Their Own Hominy
The Anna and Jacksonville State Hospitals are making
their own hominy from field corn. The recipe of the former
institution is as follows:
Take ordinary field corn; dissolve one tablespoonful of
lye in water; cover the corn with water and stir in the
lye water; cook with steam to proper state then rinse the
corn thoroughly with cold water. Much pains must be
taken in the rinsing process.
DISPENSARY
AND
OUT-PATIENT
WORK
Conducted by MICHAEL M. DAVIS. Jr..
Director of the Boston Disper\sary.
Please address items of news and inquiries regarding Dispensary and
Out-Patient Work to the editor of this department, 25 Bennett street,
Boston, Mass.
THE EVENING PAY CLINIC
.V Successful Plan for Organized Medical Practice — Bene-
fits to Patients and to Practitioners
By \. R. W.'^RNER, M.D.. Superintendent Lakeside Hospital,
Cleve.and.
The evening pay clinc is a dispensary, as we ordinarily
understand the term, which is run in the evening instead
of in the daytime and at which patients pay in the sense
that they contribute fees large enough to provide com-
pensation for all the physicians and other employees, as
well as for all the expenses of the clinic.
The first evening pay clinic was started at the Boston
Dispensary in 1913. The eye department was the first
department in operation, but other departments were soon
added. The second was started by the Brooklyn Hospital,
Brooklyn, N. Y., in 1915 and the third in Chicago in 1916.
The one at Lakeside (1917) was the fourth in this country.
The Lakeside Clinic opened in January, 1917, with two
departments, the genito-urinary and the skin and syphilis.
The attendance at these clinics rapidly increased, demon-
strating the need in Cleveland for some such institution.
That the clinic would run behind for a time was certain.
Four of our trustees, Mr. Dalton, Mr. Bourne, Mr. Bing-
ham, and Mr. Burke, agreed to meet the deficit of the
first year. By the end of the year the clinic was on prac-
tically a paying basis but with an accumulated deficit of
something over $800. In January, 1918, a surgical depart-
ment was added. Lakeside has a fairly large accident
ward service, and many of the patients are workingmen
who desire to have the hospital complete the treatment
of the accident ward. We have found that all the indus-
trial firms were annoyed by the fact that accident cases
which were placed in our wards, as soon as they became
ambulatory, were discharged from the hospital and com-
pelled to secure medical attention elsewhere. It seemed
to them a more logical procedure for the hospital to com-
plete ambulatory treatment in some department. There
are also other patients, from both the hospital wards
and accident ward, who desire the hospital to complete
the ti'eatment started, but the financial condition of many
of these patients would not warrant their admission to
our day dispensary. The growth of the clinic this spring
has been extremely rapid. It is now again on a paying
basis, and we are in the process of the establishment of
an eye department. This department will be made up of
a fully competent eye specialist, a high-grade optician to
measure frames and cheek the glasses received with the
orders, and nursing service to administer the drops.
The fees charged have been fifty cents for each visit,
144
THE MODERN HOSPITAL
with additional charges for medicine and supplies. These
additional charges vary from twenty-five cents for simple
prescriptions to five dollars for salvarsan injections.
Competent practicing physicians were secured to take
charge of the clinic, and are paid five dollars for two
hours' work. The necessary clerk, orderly, nurses and
some service by house physicians are compensated at
proper fees. An allowance is paid the hospital for heat,
light, stationery, and other routine articles.
One cannot properly appreciate what the evening pay
clinic means to the community until one has talked to the
patients. There is a certain proportion of illness of the
workingman and his family which is acute and requires
attention by a physician in the home. Into this field the
evening clinic will never enter. There is, however, a large
part of the medical treatment required, which is essentially
ambulatory. This part is mostly in the specialties. It is
most difficult for the workingman to secure this treat-
ment, because it belongs in the specialties and the man's
family physician cannot wisely serve him. It is also the
most expensive treatment which he is called upon to pro-
vide for himself and his family. As a result, nearly all
of the needed treatment is either never secured at all, or
secured at some free dispensary. The greater part of
the rest remains indefinitely on the books of some specialist
whose routine schedule of prices is too much for the
patient to pay. None of the three above-mentioned ways,
namely, (1) going without treatment; (2) taking charity;
(3) beating the specialist out of his bill, are very satis-
factory to the average workingman. Therefore, when a
man, needing treatment, realizes that this can be had from
a competent specialist at a price which he has the means
to pay and that his payments aggregated with others
provides proper compensation to the physicians and other
attendants, the satisfaction with the situation shown is
often amusing, sometimes pathetic. The average working-
man does not care to take charity, and is especially happy
when able properly to provide for himself and family.
Patients of the evening clinic express more gratitude and
appreciation than those of the hospital and day dispensary
combined, although their number is less than one-tenth
as many.
It has been interesting to note the attitude of the
physicians. The type of men selected were not those
desirous of patients for practice or experience; they were
young men grounded in their respective specialties, and
actual cash receipts constituted the most acceptable basis
for increasing their routine work. Five dollars for two
hours' regular evening work was attractive to them, and
they accepted the positions.
The equipment for the work is actually that required
for a day dispensary, with this one distinction: in the
evening clinic it is better to treat all patients as private
patients, that is, to provide an inner or private office in
which the physician receives all patients in privacy, in
exactly the way that patients consult a private doctor in
his office.
The pay clinic seems remarkably well adapted to the small
hospital, especially in mill towns and sections of the cities
surrounded by workingmen's homes. A hospital always
has either a small dispensary, emergency treatment rooms,
or other space which can be utilized in this way. A hos-
pital always has equipment far exceeding that available
in a private doctor's office. The organization and manage-
ment of a clinic are simple. The point which usually looms
as the big objection does not actually exist. This point
is the objection to competition with the practicing physi-
cian. Work which requires the presence of the family
physician in the home at any stage of the disease is not
undertaken. The work of the clinic is entirely special,
work which the general practitioner cannot wisely attempt.
Competition, if there be such, must be with specialists.
There is no occasion to argue the obligation of the work-
ingman to pay the average specialist's fees. It simply
cannot be done by the most frugal and industrious of the
working people. Specialists will do a certain amount of
work for the laboring class at nominal prices, but it is
to them a contribution of charity. A specialist's office
hours are usually in the daytime and during working
hours, making the loss of working time necessary, and
often the man will call just the day when the office is
filled with better paying patients. This is always unfor-
tunate. The practice of the specialist among the laboring
class is on the whole unsatisfactory, both to the specialist
and to the people. There will not be an excess of those
willing to give evening hours to their work. To some
five dollars clear profit without expense of any kind, seems
better than office hours, but the majority of specialists
are not available for evening work.
Much is now said about organized practice of medicine
versus the individualistic type. It is usually assumed that
physicians as a whole are essentially of the individualistic
type and opposed to organization. This is not true today,
and there are doubts if it were ever true. The develop-
ment of apparatus and equipment and the general type of
work now required for the proper practice of medicine has
placed undue burden on the medical profession. The cost
of medical service to the medical profession has increased
more than the ability of the people to pay for such serv-
ices. It has become too expensive for each physician to
maintain the equipment now actually required in the
practice of medicine and to earn a fitting return for this
expense and compensation for his preparation and train-
ing. It can be done if the fees are sufficiently high, but
all kinds of work cannot be done on fees which the work-
ing man can pay. It is generally admitted that, on the
average, half a doctor's income is required for the neces-
sary expense of equipment, office, automobile, etc. If a
physician should work for seven hours a day, at the rate
paid in the evening pay clinic of $5 for two hours, the en-
tire payment in a year would amount to $5,250, which
would thereby be equivalent to a $10,500 cash practice.
How many physicians collect $10,500 a year or better, and
on seven hours a day work? No one in private individual-
istic practice ever did it on fees the laboring class can
pay. Yet it can be done easily by organized practice.
Some maintain that the organized practice of medicine
would result in a surplus of physicians. This is not true,
because nearly all of the work done by the evening pay
clinics, which is a fair sample of the organized practice of
medicine, is work which either is (1) not now done at
all, or (2) does not now produce any revenue for the
medical profession (free dispensary work), or (3) does
not now produce enough revenue to pay the cost (present
part-pay and mostly uncollected work of the specialists) .
The average net income of physicians in any form of
organized practice would be markedly greater than it is
today. The medical profession of England was at first
somewhat skeptical about the panel system for their
compensation in state insurance, but it is now established
that these physicians are getting more money for their
services than they have ever received before. There will
be a few physicians hopelessly incompetent, whom no or-
ganization will accept under any conditions. The elimina-
tion of these few is a proper health measure which cannot
be opposed by physicians themselves.
The exigencies of war may in the near future compel
THE MODERN HOSPITAL
145
the establishment in many communities of organized prac-
tice of medicine to provide medical care not only for the
workingman, but for all the civilian population. The
large numbers of the medical profession now in the army
have created a situation wherein every physician is more
than busy. Any way which will make it possible for the
medical profession properly to treat larger numbers in
less time should be given cai'eful consideration and would
be welcomed by the majority of the medical profession.
The beginning of this may well be the establishment of
evening pay clinics, especially in industrial centers.
THE SOCIAL SERVICE EXCHANGE
Advantages to Clinics and Other Medical Institutions of
Information Furnished Through This Agency
Social service agencies and medical institutions are
gradually realizing their need of each other and coming
to see how they can supplement each other's work. One
of the most effective agencies for bringing about this cor-
relation is the social service exchange. These exchanges
exist now in many of the larger cities and their number
is steadily increasing. They are organized for the pur-
pose of providing their members with a ready means of
ascertaining, through a central agency, what other mem-
bers, if any, are interested in their client, and what they
have done or are doing for them. This facilitates quick
and intelligent handling of cases and avoids duplication
of relief and other social service.
One of the largest and most active of these exchanges
is the Social Service Exchange of New York City. In ap-
pealing to the dispensaries of New York, through the
Associated Out-Patient Clinics, for greater cooperation in
sending in the names and addresses of patients whose
ailments are sufficiently serious to have some social or
economic aspects, the New York Social Service Exchange
points out the value of the clinic of information which
can be secured from the exchange.
1. It will save time in making an investigation as to
whether or not a patient is entitled to free treatment.
2. It will give a physician a quick survey of the general
aspects of the home conditions of the patient.
3. It will enable the clinics and dispensaries to refer
cases of need, either of material relief or some special
social service, back to the agencies that have already
worked with the same patients.
4. It will prevent patients from having contact with
and being investigated by new agencies.
5. It will make available to other social agencies the
information and experience of the clinics and dispensaries
which is of great communty importance.
It will be well for dispensaries to make inquiry as to
the existence of a social service exchange in their respec-
tive communities, and, if one has been organized, to use
it freely. It will save the dispensary needless waste of
time in its social service work, protect the patient from
unnecessary investigation, and increase the efficiency of
the work of other agencies.
INDUSTRIAL
REHABILITATION
OF DISABLED
SOLDIERS AND SAILORS
What have you in your attic? Most hospital attics are
lumbered up with junk of every conceivable sort, the ac-
cumulation of years — and, as a rule, there isn't a stick in
the whole mess that can ever possibly be used again. On
the other hand, this mass of rubbish is an increased fire
risk, it takes room that might be used to house screens
during the winter and many other articles of actual value.
Conducted by ELIZABETH G. UPHAM,
Director Art Department Milwaukee-Downer College.
AX AMERICAN SCHOOL OF REEDUCATION FOR
CRIPPLED MEN
The Work of the Red Cross Institute for Crippled and Dis-
abled Men of New York City— The Methods of
a Special Employment Bureau for the
Handicapped
By DOUGLAS C. McMURTRIE, New York. Director of the Red Cross
Institute for Crippled and Disabled Men, President of the Federa-
tion of Associations for Cripples, Editor of the American
Journal of Care for Cripples.
[Continued from July issue.]
THE LIBRARY
As the institute is working in a new field, in which de-
scriptive literature, reports, and studies are extremely
scarce, it is absolutely essential to the intelligence of its
work that it maintain its own library. The present li-
brary is made up of my private collection of litera-
ture concerning cripples gathered during the last eight
years and by additions of the later material which
have been acquired by the institute since its estab-
lishment. The collection contains every item relating
to cripples which it has been possible to obtain either by
purchase, gift, or exchange during the last eight years,
and every care has been expended to make it as complete
as possible. It can safely be said that the present library
constitutes the largest collection in the world dealing with
this subject, if not the only collection of considerable ex-
tent. The material covers work for crippled children as
well as for crippled adults. It consists of approximately
thirty-five hundred separate books, pamphlets, reports,
and articles in periodicals.
The collection is completely indexed by author and sub-
ject, and there is now being made a minute analytical sub-
ject index which will refer not only to complete articles
or reports, but to the separate sections and paragraphs of
all the material. This will make possible, for instance, the
immediate location of every reference in the literature to
the teaching of motor mechanics or every reference to the
provision of artificial limbs.
There has also been prepared a bibliography of the war
cripple and supplements listing the current publications
will be issued at frequent intervals. Over sixteen hun-
dred items relating to the rehabilitation of disabled sol-
diers and sailors have already been indexed. The collec-
tion is used principally by members of the research staff
of the institute, but it is open freely to the public for con-
sultation and study.
RESEARCH DEPARTMENT
In euiering upon a program of reeducation for crippled
men, the first necessity was to learn the experience of
others so as to avoid the mistakes which had been made
and to follow out the methods which had been found sue-
146
THE MODERN HOSPITAL
cessful. This was not so simple as might appear, for the
reason that there was no standardized practice, and, as
the work was all so new, there had been little opportunity
for reporting upon it.
The first effort was to ascertain all the centers on the
continent, in Great Britain, and in Canada, at which re-
educational work was in progress. Correspondence with
the officials directing this work was immediately instituted,
every available item of printed matter was collected, and
photographs and illustrative material obtained.
The next move was to study the materials so gath-
ered. This work was undertaken in the early summer by
the present director of the institute and continued in the
fall by a staff of research associates who were assigned
to specialize individually on work in the various countries
engaged in reconstructing their disabled soldiers. Thus,
to one fell the responsibility of studying the work in
Great Britain, to another of the work in France, to a third
of the work in Italy and Germany, and to still another of
the work in Canada and the other British dominions. As
a result of these studies, there have been prepared reports
describing the practice and organization of reeducation
in the various countries. These are being issued as sci-
entific publications of the institute.
Among the reports already prepared and issued are
publications describing work in Canada, Great Britain,
France, New Zealand, Germany, and Italy.
PUBLIC EDUCATION
In the rehabilitation of disabled men, an absolute essen-
tial is cooperation on the part of the public. The commu-
nity must have intelligence regarding the methods and
sympathy with the aims.
Up to the present time, the attitude of the public to-
ward the cripple has been singularly pernicious, and of
decided hindrance rather than help in his efforts to make
good. The people have been ready — all too ready — with
sympathy proceeding from the heart but not from the
head. There have been alms in plenty for the cripple on
the street and public asylums open to shelter him. But
there has been no assistance of a constructive nature. The
hospitals in which he was treated turned him out before
he was in shape to face life again ; there have been no
schools in which he could be trained for a trade possible
to his capacities. Even for those in a position to do work
of a certain character, there have been no special place-
ment agencies to seek out for him the suitable job.
Employers have considered the cripple helpless and
have denied him opportunity of trial at any job worth
while. A position as watchman or doorkeeper was about
the best he could e-xpect.
The individuals among the family or acquaintance of
the cripple have condoled with him regarding the black
future ahead. They have assumed him helpless and, only
too often, convinced him of the validity of their surmise.
It is evident that, if reconstruction work with crippled
man is to be successful, this attitude must radically be al-
tered. The employer must be brought to think: "Too bad,
but we must not think of any charity job. We must look
around to pick out for you a job at which you can be as
useful as before the amputation." The reaction of the
individual must come to be: "That was hard luck, but you
will get along all right. Think of all the cripples, more
seriously disabled, who have made real successes and are
now happy and self-supporting."
The public demand on the cripple must be that he
fight for his independence, rather than subside into an ob-
ject of pity. And the community must then be prepared
to stand by with the right kind of help.
One duty of a pioneer institution thus becomes clear.
The pernicious attitude can be metamorphosed only by
an extensive, persistent, and patient campaign of public
education. The institute has accepted its share of respon-
sibility in this field and has inaugurated educational effort
directed through a variety of channels.
The work of reeducating disabled soldiers for self-sup-
port is one which has laid hold of the public imagination
in the European countries. There seems no better method
of committing our own countrymen to similar effort than
to tell in the public press, in an interesting fashion, of
what is being done abroad. A news service to the daily
press, sent out about once a week, has been instituted, and
it has been found that the material has very generally
been utilized. The first story told of the reconstruction
of crippled peasants in Italy; the second described the
splendid accomplishment by the Belgian authorities in
making their disabled and expatriated soldiers a national
asset rather than a liability. The third article recounted
the work of a great reeducational school at Dusseldorf,
Germany, and pointed out several ways in which we
might learn from our enemy; the fourth story dealt with
the pioneer effort in France to build up facilities for re-
habilitation of the crippled poilu, and there are many
others which have been sent out, or which are in prepara-
tion. It will be noted that these are not publicity stories,
but real news articles. The institute is not mentioned in
them, except to assume responsibility for the statements
made.
A related activity has consisted in writing "letters to
the editor" purposed for publication in the daily press
throughout the country. The general aim of these letters
is to call attention to matters of moment to the cripple.
One asked for suggestions from readers as to jobs in which
one-armed cripples could profitably be employed. Many
helpful replies were received, but the chief advantage was
derived in the large number of people who were brought
to think about the question.
When occasion demands, there are issued to the daily
press bulletins of different character, with the purpose of
informing the public regarding the actual activities of the
institute — its establishment, the inauguration of new de-
partments, and current work. By "letters to the editor,"
the attempt is made to reach employers and interest them
in the objects; also to reach cripples and inform them of
the facilities at their disposal.
Periodical articles, with their excellent possibilities of
illustration and the special character of their circulation,
offer an apt medium for educational material. In an ef-
fort to reach directly the workers and employers in as
many industries as possible, there have been prepared, for
the trade journals, a series of articles. Each article is
specially written for the trade in question and tells of in-
struction in that trade actually being given to war cripples
in the reeducational schools abroad, thus reaching the
reader on the field of his own particular interest as related
to the war. Contributions on the reeducation of war crip-
ples in the electrical field, in leather work, in shoe-repair-
ing, in jewelry-making, and in carpentry have already
been published.
The institute has gathered an extensive collection of pho-
tographs illustrating reeducational work in all the bellig-
erent countries. This now numbers over three hundred
subjects.
From the most interesting subjects in the photographic
collection have been made sets of lantern slides. The in-
stitute is also building up a collection of moving picture
films illustrating the work of reeducational centers in
THE MODERN HOSPITAL
147
other countries, or showing successful cripples in action.
The latter reels prove a great encouragement to disabled
men.
With interest in reconstruction work growing apace,
the demand for speakers to discuss the subject before
conventions and meetings of one type or another has been
frequent. Members of the institute staff have endeavored
to respond to every reasonable request.
In order to take the initiative in arranging for discus-
sion of reeducation for crippled and disabled men before
a larger number of audiences, there has been organized
a speakers' bureau for which volunteers were recruited
and trained.
This article is not a record of accomplishment, for the
institute is only entering upon its task — a difficult task, in-
deed. Its principal purpo.se is to interpret the problem of
the military and industrial cripple as it has been seen, to
indicate how some of the preliminary questions have
been decided, and to describe the methods and manner of
attack on the citadel of the reeducationist's intention.
There is no royal road to wisdom in dealing with the
cripple. Experience is the only dependable teacher. What
little of such experience the institute may have at any
stage of its development will always be available to others
who may come to share its enthusiasm and aim.
Smith-Sears Bill Passed
The United States has taken the first step in providing
rehabilitation for her disabled soldiers and sailors by pass-
ing the Smith-Sears bill, which became a law June 27.
The outstanding features of the bill to provide that all
occupation given for therapeutic purposes is under the
direction of the Surgeon-General in consultation with the
Federal Board for Vocational Education, so that such
occupation may be, wherever possible, a part of a con-
tinuous course of training, and that the Federal Board for
Vocational Education shall provide all vocational training
after the men have completed their hospital treatment and
are discharged from the army.
Since Congress has appointed the Federal Board for
Vocational Education responsible for all reeducation after
the soldier's discharge from the hospital, this Board is
engaged in building up an organization for the discharge
of this mammoth task. In this effort the Canadian govern-
ment is proving of great assistance in lending Mr. T. B.
Kidner, vocational secretary of the Invalided Soldiers
Commission to the Federal Board as advisor. Mr. Kidner
-has been called to Washington in consultations during
the past winter, and testified at the hearings of the Smith-
Sears bill. The knowledge that Mr. Kidner is to assist
the American government in this great enterprise is
welcomed throughout the country by those interested in
rehabilitation who know of Mr. Kidner, his \'ision and
work in helping to develop the present organization in
Canada.
The experience of all the countries in rehabilitation has
been compiled by Douglas C. McMurtrie, director of the
Red Cross Institute for Crippled and Disabled persons,
and published by the Federal Board for Vocational Educa-
tion as Bulletin No. 15 entitled: "The Evolution of Na-
tional Systems of Vocational Reeducation for Disabled
Soldiers and Sailors." This bulletin will be sent free upon
request.
Look inwards, for you have a lasting fountain of happi-
ness that will always bubble up if you will but dig for it. —
Meditations of Marcus Aurelius.
THE SOUTHS FIRST SCHOOL OF SOCIAL WORK
AND PUBLIC HEALTH NURSING
Courses in Public Health Nursing — Field Work in the
Public Health Service of Richmond — Training
Social Workers for War-Time Work
By henry H. HIBBS. Jr.. Ph.D., Director, School of Social Work
and Public Health. Richmond, Va.
Last fall there opened in Richmond, Va., the first school
for social workers and public health nurses to be estab-
lished in the South. It was established partly as a result
of a long-felt need for more available opportunities for
training in the South and partly to meet the increasing
need for social workers and public health nurses which
the war has produced.
The lack of any well-organized school for the training
of public health nurses and social workers in the South
has been the subject of comment for some years. As the
chief health officer of a large Southern city has pointed
out, "We are forced to employ graduate nurses with no
social or public health training with the hope that after
we put them to work we can give them the social and
preventive viewpoint which the health nurse must have
to be successful. But too often this is a vain hope. How-
ever intelligent and devoted to her work the nurse may be,
we find that the pressing requirements of her daily rou-
tine prevent her from acquiring, or the chief nurse from
teaching her, the things the ordinary graduate nurse must
learn to become successful in public health or visiting
nursing."
Organizations and individuals interested in public health
nursing have hoped that such a school might be established
in Richmond because of the extraordinary fine visiting
nurse service for which Richmond has been justly famous
for many years, and because both the city and state de-
partments of health have recognized the importance of
public health nursing and provided liberally for it. With
so admirable a background for field work, writes Ella
Phillips Crandall, secretary of the National Organization
for Public Health Nursing, "we have looked upon Rich-
mond as the most strategic city in the South for such a
school."
Such a school has now been established in Richmond
as a division of the School of Social Work and Public
Health. The school opened on October 1 with two students
enrolled in the eight months' course and four in the four
months' course. This enrollment, while very small, was
not regarded as discouraging, since plans had been made
rather hastily and no well-organized effort had been made
to get the advantages which the school offered and the
need for public health nurses before the graduate nurses
of the state.
A four months' course was later announced to begin
February 1. This course was more carefully planned,
and every effort was made to interest the nurses of
Virginia and neighboring states. As a result, a gratify-
ingly large body of students was enrolled in a relatively
brief period of time. Eleven of the nurses came from
Virginia, five from North Carolina, and one each from
South Carolina, Tennessee, New Jersey, and Kentucky — a
total of twenty.
The courses offered are as follows: (1) public health
nursing; (2) public health nursing (advanced); (3) sani-
tation and preventive medicine; (4) the health of school
children; (5) public health administration; (6) publicity in
public health work; (7) mental hygiene and mental dis-
ease; (8) general introduction to social work; (9) com-
munity social work; (10) economics.
148
THE MODERN HOSPITAL
THE WAR:
ITS HOSPITAL, MEDICAL
AND NURSING ASPECTS
Work of English Sculptors in Repairing Facial Injuries
Captain Derwent Wood, A. R. A., does work of a most
unusual character; he is a builder of human faces. Work-
ing in the Masks for Facial Disfigurements Department,
Copyright Underwood & Underwood, New York.
Fig. 1. Various plates and attachments in different stages of com-
pletion. The lower row. from left to right, shows the mask mold,
the mask cast, the cast with the good eye restored, the plate
molded, and the finished plate attachment.
Captain Wood transforms the hideous, often faceless,
wrecks of war into men whose countenance shows no
repulsive features. New noses, eyes, cheek-bones, jaws.
Copyright Underwood & Underwood, New York.
scribes the work done by Captain Wood and other sculp-
tors. The injured soldier, if possible, provides a portrait
of himself before his injury. This serves as a model for
the sculptor. Next a cast is made of the patient's face
and the cast is put through various processes to make it
a perfect basis for the artist, who then builds up the new
face.
"The eyeless socket is filled in and given an eye, eye-
brow, and eyelashes which pair with their neighbors; the
concave cheek is made convex to pair with the good cheek;
the nose is restored, its shape reproduced from measure-
ments and from comparison with the photograph."
Fig. 3. A patient
to cover the '
R.A., Third I,<
Copyright Underwood & Underwood, New York,
with a plate which has been fixed to hold spectacles
vound. The sculptor was Captain Derwent Wood,
pndon General Hospital.
sometimes almost entire new faces are constructed by
Captain Wood, who before the war was a sculptor.
Ward Muir, in the Nineteenth Century Magazine, de-
A mask is made from electrotype plate, paper-thin. At
first it is not tinted but is shaped with great care. "Very
painstakingly is the patient fitted." The plate is then
covered with an electric deposit of silver. The artist then
paints, on a slim oval disk of glass, an eye which is a
marvelous reproduction, even to the veins in the white,
of the patient's uninjured eye. The mask is completed
by being painted in colors which are an exact match for
the patient's skin. Little support is needed for the mask,
as it is very light.
"At a slight distance, so harmonious are both the mold-
ing and the tinting, it is impossible to detect the join
where the live skin of cheek or nose leaves off and the
imitation complexion of the mask begins. Figure what
this means to the patient."
CORNERSTONE OF FIRST RECONSTRUCTION
HOSPITAL LAID
Order of Elks Present to the Government Reconstruction
Hospital on Parker Hill, Boston
On June 15 the cornerstone of the first hospital in the
United States thus far dedicated to the reconstruction of
maimed and disfigured American soldiers was laid on
Parker Hill, Boston, adjoining the Robert Brigham Hos-
pital and overlooking Bunker Hill and the historic heights
of Dorchester. It will be known officially as Government
Hospital No. 10. This reconstruction hospital will cost
about $250,000, and is one of a series to be erected later
THE MODERN HOSPITAL
149
by the grand lodge of the Benevolent and Protective Order
of Elks from a fund of $1,000,000 which was raised by
the various lodges throughout the country.
When the Order of Elks met in annual convention last
year in Boston and faced the question of what they as
an order might do to assist the government in the prose-
cution of the war, the seventeen hundred members there
gathered unanimously voted $1,000,000 for war relief. A
commission appointed to determine the use to which the
money was to be put decided that the principal purpose
for which the money should be spent should be hospitals,
and learning that it was the desire of the government
to establish its first orthopedic or reconstruction hospital
in Boston, made haste to offer to purchase a site and
erect suitable buildings for the purpose, an offer which
was gladly accepted by the United States soon after its
general nature and plan were unfolded. The site next to
the Robert Brigham Hospital was chosen because the
trustees had come forward with the offer of every pos-
divided into seven small wards for the use of the commis-
sioned officers who will be assigned by the war depart-
ment to the management of the hospital.
The central part of the main building contains a large
hall, two administration offices, one on each side of the
entrance, and a double staircase to the second floor. Run-
ning back from this central portion of the main building^
through the center of the square formed by the ward
buildings and the corridor which connects them at the
rear is a large mess hall and serving room. The hospital
will be supplied through the tunnel and corridor from the
kitchen of the Robert Brigham Hospital.
A large elevator will run from the basement to the
second floor. In the rear of the connecting corridor is to
be built the hydrotherapeutic department. This is to be
constructed in the shape of a cross and divided into three
compartments, each one devoted to a different method of
treatment, one for baths, one for massage and one for
exercise rooms.
sible help from its fine central plant in the way of light,
heat, kitchen, laundry, chemical laboratory, x-ray facili-
ties, and operating room. This had made it possible to
avoid heavy construction and thus hasten the work. It is
expected that the buildings will be ready for occupancy
on October 1 next.
Every device and resource known to science will be on
hand to rebuild every part of the human frame. Dr.
Frederick J. Cotton, it is reported, will be in charge of
the hospital for the government. The hospital will require
a well-ti-ained and especially efficient professional staff.
Its necessary nucleus has been recruited and will be ready
to begin its work as soon as the hospital buildings are
completed and equipped.
From the plans of this hospital and from the experience
gained there it is intended to establish the model for
reconstruction hospitals throughout the country. The
main building will consist of seven open wards, two stories
high, each containing a diet kitchen, toilet arrangements,
day room, nurses' room, and linen closet. These wards
provide for thirty-four beds each. An eighth ward is
In the rear of the ward buildings and contiguous to the
hydrotherapeutic department, on each side, are to be the
shop and barracks. The shop building will be divided
into two departments, where the patients of the hospital
will be taught to use their restored members and be
instructed in new trades.
In the barracks will be housed the orderlies and male
employes connected with the hospital. The general style
of the building suggests the southern colonial.
The Board of Trustees of the German Hospital, in
Brookljm, has dropped the old name, and are now calling
the institution the "Wycoff Heights Hospital."
"Doctor, if I follow all the rules you have given me life
won't be worth living."
"ThaC is for you to judge, sir. Under those conditions
I don't believe life would be worth living, either, but as a
conscientious physician I must tell you what you'll have
to do to regain your health." — Birmingham Age-Herald.
150
THE MODERN HOSPITAL
Affiliation for the Small Hospital
To the Editor of The Modern HosI'ITAL:
I should like to ask your advice about a question con-
cerning the policy of this hospital which is very important
to us at present, in fact, a question that has aroused so
much controversy that the solution of it will probably de-
cide whether the work of the hospital will be continued
or not.
We are in a very small city, but the people of the town
and the surrounding towns are dependent on us for hos-
pital care. We have only 25 beds, and our average daily
census is not more than 13.
When the hospital was first opened, we had a training
school, but found it expensive to train nurses and hard to
get probationers for such a small school, as our graduates
could not register without further training in a larger
hospital.
The training school was discontinued about two years
ago, and we have been taking in girls who receive a small
salary, and we give them what practical training we can
in the care of patients. This plan is objected to by the
registered nurses of the state, and they are creating a lot
of gossip about the care of our patients. On account of
this, it is getting to be difficult to get graduate nurses to
care for special cases in the hospital or to take charge of
the nurses. We should appreciate any advice you can
give us. A Superintendent of a Small Hospital.
Twenty-five-bed hospitals can and do support training
schools and give nurses good training so far as their
clinical material will supply it, and make that training
fully meet the requirements for state registration by an
affiliation with one of the large hospitals of the state.
Unless you can do this, the next best thing for you to do
would be to engage enough acciedited graduates to care
for your patients.
How to Lay Battleship Linoleum
To the Editor of The Modern Hosi'Ital:
Will you kindly tell me the best way to lay battleship
or any other good linoleum on worn wooden floors ?
A Canadian Hospital.
Wooden floors should be perfectly dry before linoleum is
laid. The surface should be smooth and even and free
from all dirt and foreign matter. A good carpenter can
scrape the floors so as to produce a satisfactory surface.
All cracks must be filled and protruding knots or nails
must be smoothed down. The preliminary preparation is
very important because any unevenness in the floor will
in time show in the linoleum. Moisture on the floor will
cause mildew or mold. The linoleum may be laid either
directly over the wooden floor or over a layer of felt paper.
Linoleum floors are most satisfactory laid over a cement
base. The success of the flooring seems to depend on the
material used to hold it to the base which will not cause
raised places after the wear has begun.
Floors of linoleum tiles or squares are more easily re-
paired and kept in condition, and cracks or raised places
are easily avoided by the repair of one or more tiles at
a time, when necessary.
The Graduate Night Supervisor a Necessity
To the Editor of The Modern Hospital:
Do you consider it necessary in a small hospital of only
thirty-five beds to always have a graduate nurse in charge
of the hospital at night? Besides myself, there is one
day assistant, who also serves in the operating room. Our
trustees do not want to add a third graduate to the salary
list, and wish me to keep a senior nurse in charge at night
and my assistant on call when needed. Will you let me
know what other hospitals are doing about this?
Superintendent of Small Hospital.
This question arises frequently in the smaller hospitals.
The salary list is a rather serious part of the economic
problem and must be considered, but, on the other hand,
we believe that doing without the graduate night supervi-
sor is poor economics.
No graduate assistant can give good supervision to the
hospital in the daytime and be subject to call at night, and
no senior nurse should be asked to take the entire respon-
sibility for obstetrical cases, emergencies, or the post-op-
erative care of patients.
You will find that just one accident in your hospital or
one case, of either real or fancied neglect, which can be
laid to the lack of a night supervisor, will do your hos-
pital more harm in the community and prove a greater
economic loss to you than can be balanced by the money
saved on the salary list.
Redecoration of Operating Room
To the Editor of The Modern Hospital:
We are writing you concerning the redecorating of our
operating room in our local hospital. This room is about
14 by 18 with a large bay window facing the east.
The plastering consists of two-coat work. The white
coat commenced cracking and chipping off about four
years ago. We then repaired the breaks and decorated
the walls with wall paint, but have the same trouble again
only worse. We would like to avoid removing the plaster-
ing if possible. Are there any paper or oil cloth composi-
tions that could be used? If this is possible, would a soft
gray be more suitable than white?
A Middle- Western Hospital.
Old plaster walls in an operating room such as you
describe could be covered with a glossy finished oilcloth,
applied in a manner similar to the application of wall
paper, but it is doubtful whether the cracks and pits could
be filled smoothly enough to produce a good result.
Assuming that your plaster is on clay tile, gypsum block
or metal lath, the appearance and wearing quality would be
more satisfactory if you would have the white coat of
plastering removed and a thin coat of Keene cement
applied. An experienced plasterer acquainted with the
working of this cement would insure a permanent perfectly
smooth job for oil painting or enameling which should
not have any imperfections, such as would be visible
through any oilcloth material applied on existing plaster
work, however careful the attempt had been to smooth
over the defects.
A soft giay or light, green color is now generally con-
sidered more suitable than white for the walls of oper-
ating rooms. It is now recognized that the eff"ect of the
reflection of bright daylight from the floors and walls on
the eye of the operator causes an eye strain that affects
in an unsatisfactory manner quick and accurate work, and
there is coming to be a preference for gray or green-
walled operating rooms.
The world would be better and brighter if our teachers
would dwell on the duty of happiness as well as on the
happiness of duty. — Lubbock.
THE MODERN HOSPITAL
151
CURRENT
HOSPITAL
LITERATURE
ALBERT ALLEMANN. M. D.. Foreign Literature.
Army Medical Musrum and Library. Office of the Surgeon-Cerxeral.
United Stales Army.
The AVork of the Adolescent Clinic of Stanford University
Medical School. Amelia E. Gates, M.D. Arch Pediat
1918, XXXV, No. 4.
About a year and a half ago, a separate clinic for girls
from 11 to 16 years old was established at the out-patient
department of the Stanford University Medical School as
a branch of the children's clinic. The work aims to em-
brace the prepubescent, pubescent, and early postpubescent
period, and Dr. Gates' report is based on the work done
with the first hundred girls. While certain medical aims
were in view when the work was started it was soon found
that it was not possible to confine it to medical work alone.
In proportion as the social and educational aspect of the
problems was dealt with, the work became more effective.
The interest taken by the mothers in the work and their
intelligent cooperation is said to be most gratifying. The
clinic is held once a week after school hours so as to allow
of frequent presence without loss of school attendance.
During the year and a half of its existence the clinic has
assumed the character of a girls* club. Manual work
such as bead-making, basket-weaving, etc., has been intro-
duced, and many of the girls look forward to the Wednes-
day afternoons and their little talks with the clinic staffs,
knowing that they can bring their small troubles and
worries there with assurance of sympathetic understanding
and attempt at effective help, for physical ailments are
not the only ills dealt with in this clinic, but also those
coming from the various social maladjustments of modern
life, such as uncongenial or inappropriate home environ-
ment, mental overstrain, and worry over vocational choice.
The medical problems of adolescence fall into three
divisions, those dealing with physical, mental, and psychi-
cal state of the individual. Among the conditions specially
studied are physical development (as indicated by increase
in weight and height); the anemias; the menstrual dis-
turbances; the condition of the thyroid; the vasomotor
disturbances; the nervous disorders; postural defects; the
different forms of enuresis. Failure to make gain in
weight and height in proportion to age is found to be due
in many cases to insufficient nourishment, and whenever
a girl in good physical health is not making a satisfactory
gain in weight, the quality and quantity of her food are
thoroughly investigated. Direct medication for anemias
has been largely abandoned in favor of general hygienic
measures, good food, fresh air, cold bathing, etc. In the
treatment of anomalies of menstruation the work has been
largely educational and the results have been very satis-
factory.
In the investigation of the mental status of the patients,
the Binet-Simon scale showed a retarded mentality of from
one to five years in 71 percent of cases, and the conclusion
wa.s leached that the adolescent period was one of mental
arrest. A check on these results by means of a point
scale forced a revision of this conclusion, indicating that
many who had tested out much retarded by the Binet
scale were normal by the point scale. Dr. Gates concludes
that while the Binet may be adequate in the examination
of children below eleven, after that age the point scale is
far more reliable.
In dealing with the psychic phenomena, work with the
parents is as important as that with the patients them-
selves. An interesting observation is that the psychic
problems are easier to solve in the case of girls from
the associated charities under the care of a foster mother
than in those who are in their natural families, for in the
former case, if the mother be not the right sort or the
environmental influences not the best for the child, the
mother can be changed and the right surroundings secured,
but uncongenial home surroundings cannot be discarded
in the case of a child under the care of her own family.
The abnormal psychic conditions most frequently found
are lack of emotional control, increased sensibility, over-
anxiety as to physical condition, and overconscientiousness
leading to depression. No recognized case of dementia
precox was found.
On the social service side of the work much is to be
done, and a small corps of social workers could be kept
busy. Two of the most pressing needs are instruction in
dietetics to the mothers and provision of wholesome amuse-
ment for girls in their leisure hours.
Physical Status of Juvenile Delinquents Based Upon
Physical and Clinical Examinations of Children in the
Reformatories of the City of New Orleans. Elizabeth
Bass, M.D., and Maud Loeber, M.D., South. Med. Jour.,
1918, XI, No. 5.
Drs. Bass and Loeber undertook this study to ascertain
the condition of the children committed by court order to
the reformatories in the city of New Orleans with the pur-
pose of discovering physical conditions which might have
a direct bearing upon crime. The question raised by the
authors is whether the court should not be in possession
of such facts before the disposition of the case is made.
Only tests within the scope of a routine office examination
were made, since it was considered that possibly only a
short time would be permitted a physician appointed by
the court for examining children prior to their final com-
mitment. The examination made covered general appear-
ance, posture, development, and nourishment, including
under "head," scalp, eyes, nose, mouth, teeth, throat, ears
and glandular enlargements; under "chest," the heart and
lungs; under "abdomen," normal or abnormal, distended,
presence of masses; under "special," skin and reflexes;
under "clinical," blood, differential leukocyte count, and
under "feces," presence of intestinal ova or parasites.
Wassermann, sputum, and urine examinations were made
only on children whose general appearance or physical
findings suggested a condition wheie these examinations
would aid in diagnosis. The author says:
"From our observations we believe that many of these
children who are sent to our reformatories would make
better men and women if even this superficial attention
were given to them before their commitment by a physician
attached to the juvenile court, to be followed up in each
instance, according to the opinion of the court, either by
the child's natural or rightful guardian, or, should the
court deem commitment pi-oper, by the custodian of the
municipal or state institution.
152
THE MODERN HOSPITAL
"Our suggestions, therefore, would be:
"1. A conscientious routine physical and clinical exam-
ination, with recommendations on the case to the court
before commitment.
"2. Penalty exacted of the natural guardian in cases of
neglect to care for the physical defects of the child or
children in his care.
"3. Physical and clinical records kept of each child at
time of admission into reformatory, and observations re-
corded once each month thereafter, or more frequently
should the case require it.
"4. Each reformatory attending physician should have
as his assistants specialists in the various branches of
medicine, as staff officers, to regularly visit and treat cases
needing attention in his specialty.
"5. A resident trained nurse.
"6. That the diet and mode of life in an institution be
passed upon by that institution's attending physician."
The Pitiable Condition of the Insane in North China.
J. H. Ingram, M.D. China Med. Jour., March, 1918,
XXXII, No. 2.
Dr. Ingram says that the need of an institution for the
insane in China can scarcely be overestimated. The only
institution for the care of the insane in China in which
modern principles are employed is in Canton. This insti-
tution, which is 1,500 miles distant from Peking, is over-
crowded, and, moreover, the language difficulty is a great
one, for the Cantonese dialect is not understood by people
from other parts of China. As the insane are cared for
by their families and as the diseased condition of the mind
is not understood, they are cruelly treated because re-
garded as accountable for their actions. Moreover, since
a family in China is responsible for the acts of any of its
members the family feels compelled to protect itself even
by the most inhuman measures.
One case which Dr. Ingram cites is that of a young man
who became mentally deranged when about to graduate
from one of the mission schools. As suitable provision
for caring for him was not available, the patient's father
was asked to take charge of him and the father, to pro-
tect himself against accountability for his son's actions,
drowned him in the river. Another case was that of a
man violently insane whose mother had his leg and arm
broken in order that he might not be able to terrorize
the neighborhood. His sufferings were so great that he
managed to commit suicide.
There is a place in Peking sometimes called an asylum
for the insane, but, according to Dr. Ingram, it is nothing
more or less than a prison where patients are confined
and put in chains when necessary, no care being taken
for their physical comfort and well-being. At one time
Dr. Ingram found that this place was overrun with about
one hundi-ed and fifty petty thieves, for whom no other
jail accommodations could be found.
The Care of Convalescents in the Ospedale Maggiore of
.Milan. E. Ronzani. Osp. Maggiore, Milan, 1918, V,
No. 3.
As early as the sixteenth century the great Milanese
ho.spital set apart certain buildings for the care of the
convalescents, but the great number of patients and the
lack of funds have always interfered with carrying out
an efficient service of this kind. In 1841 the Marquis Secco
Commeno donated one million francs to the hospital for
the service of convalescents. But little was done at the
time until in 1907 Signora Luigia Corti donated another
half million francs for the same purpose. It was then
decided to construct two large pavilions for the reception
of convalescents, but the erection of the buildings was
not carried out until 1916. The two one-story pavilions
are built in the barrack style. Each one is .50 meters long
and 8 meters wide (about 160 by 26 feet). The floor is
of cement and raised 0.7 meters (about 2 inches) above
the ground. The walls are of hollow tiles set in cement.
A gallery 4 meters wide, intended for heliotherapy, runs
along the whole south front of the pavilions. Each build-
ing has room for thirty-six beds. The beds are ranged
along the two long sides with an ample gangway between
the two rows. A physicians' room, a nurses' room, a
small kitchen, etc., are at one end of each pavilion. The
total costs of both buildings amount to 90,000 francs
($18,000) or 1250 francs ($250) per bed.
How to Prescribe Rest and Exercise for Patients with Pul-
monary Tuberculosis M. Segard. Jour, de med. et de
chir. prat., Paris, 1918, LXXXIX, No. 1.
For patients with active tuberculous processes, rest takes
first place as a tonic, antipyretic, and antitoxic. But in
the rest treatment two rules must be strictly observed:
1. The patient should always lie down for two hours before
the two chief meals and for two hours afterwards. Only
thus vidll digestion and assimilation properly take place
and toxic anorexia be avoided. 2. If during any exercise
the least rise of temperature is noticed or the pulse rate
rises above 100, the exercise should at once be stopped.
In English sanatoriums Paterson's treatment by exercise
takes, of late years, a prominent place and good results
are reported, but we should never forget that the Pater-
son treatment, in spite of its advantages, is applicable
only to patients who show no fever, who are carefully
selected, and whose exercises are methodically carried
out and supervised.
The Economic Problem of the Italian Hospitals for the
Insane. C. Agostini, Quaderni di psichiat., Genoa, 1918,
IV, No. 9.
As the Italian hospitals for the insane are very much
crowded, they are laboring under financial difficulties.
Pood being the most important factor in this question, the
condition could be remedied by establishing special institu-
tions for the chronic and incurable patients. In this man-
ner, the manicomiums would be given back their true
character as hospitals for the cure of mental diseases.
Thus the institution would acquire greater dignity and
the physicians could better study the nature of the various
diseases. The hospitals at Rieto, Spoleto, and Foligno
have followed this plan for the last twenty years, and it
has proved a success.
The Syphilis Clinic of Emery University, Atlanta, Ga.
W. B. Emery. Am. Jour. Syph., St. Louis, 1918, II,
No. 1.
The dispensary is open four afternoons each week, Mon-
days and Wednesdays for women and Tuesdays and Fri-
days for men. During the months of October and Novem-
ber, 1917, 903 treatments (mercury with injections of the
arsenical preparations) were administered. Several as-
sistants act as representatives of the various departments.
Those from neurology and pediatrics do especially valuable
service, the first being of great assistance in spinal work
and the latter in the handling of children. Educating and
instructing the patients concerning the nature of their
disease forms a special feature of the treatment.
THE MODERN HOSPITAL
153
NEW
INSTRUMENTS
AND EQUIPMENT
VINCENZ MUELLER. Technical Editor.
GEO. W. WALLERICH. Associate Editor.
Please address items of news and inquiries regarding New Instru-
ments and Appliances to the editor of this department, 327 Southeast
e. Oak Park, Illinois.
TliiTniolitf Heal and Liyht Infuser
There are few other methods so efficacious in restoring
normal circulation in the body as the application of radi-
ant liprht and heat rays from a scientifically constructed
reflector. The Therniolite here illustrated so directs the
rays that when applied over the aching parts they not only
affect the surface of the skin, but penetrate deep into the
tissues, relaxing the congestion and relieving the pain. It
is a simple and practical portable device for convenient
application of radiant light and heat where larger and
more elaborate apparatus is not available.
New Sputum Cup
A new sputum cup, which we believe will be of inter-
est to the superintendents of tuberculosis sanatoriums
and hospitals in general, has been devised by Mrs. Bertha
M. Logan, superintendent of the Rockford Municipal Tu-
berculosis Sanitarium, of Rockford, 111. This seems to be
a great improvement over the metal holder and filler cups
^^ h.^^'
Logan sputum cup.
mostly in use at present, inasmuch as it eliminates the
handling and cleaning of holders, also does away with the
added cost of the metal holders.
The device is a paraffine cup, absolutely solid, which
could remain filled with sputum for forty-eight hours with-
out any sign of softening. It can be dropped in the sack
at the bedside of the patient, the sack closed and burned
without further handling. This cup will also appeal to the
esthetic sense of the patient, as well as of the attendants,
since the contents are never exposed to view.
Thermolite heat and light infuser.
The Thermolite is a scientifically made instrument, as
every detail of its construction has been carefully consid-
ered and every underlying principle for correct radiation
of heat and the intensity of heat have been thoroughly
worked out. The Thermolite rays do not focus; the con-
struction of the reflector is such that the rays are parallel
so that all of the light and heat generated by the lamp are
thus preserved in their various qualities. The heat rays
are effective over an area of approximately 50 square
inches and are not focused in a small burning spot, so that
the lamp may be used in applications of light for periods
of one to two hour . in severe cases where such continuous
use is necessary.
The Safety Electric Warming Pad
In these days of cheap electric power, now available ire
the smallest cities, one is always interested in devices
which can be electrically operated, and especially if their
use tends toward economy. Electrically heated pads have
innumerable attractions and are being extensively adopted
by hospital superintendents, from the fact that they are
clean to handle, require no replenishment of water, as
with hot-water bottles, contain no rubber, which will soon
deteriorate, and are light in weight. The amount of elec-
tricity which the better grades of pads consume is small,
so the item of current cost is easily offset by the many
conveniences afforded in using an electric pad.
It is not many years ago since the electrically heated
pad was considered dangerous, and justly so in some cases.
Experience, however, has overcome the faults, and the bet-
ter grades of pads now made may be considered in every
154
THE MODERN HOSPITAL
way safe to use. The "Safety" electric warming pad here
illustrated is offered by a manufacturer who has given his
product the most careful attention as regards construc-
tion. One of the weakest points of construction in the
older types of pads was the fact that the pads continued
to heat and, with current passing for some time, became
too hot, charring the insulation and occasionally doing
damage. In this pad an excellent thermostatic switch is
used, so that practically any heat from room temperature
to about 180 degrees may be had, this temperature being
held just at the desired point. To set the temperature it
is necessary only to turn a small knob to the heat wanted,
when this heat will be exactly held.
Safety electric warming pad.
In an appliance which is handled a great deal it is
naturally important that all wiring and heating elements
be carefully protected. The "Safety" pad is indeed dur-
ably made in this respect. All pulling, bending, or twist-
ing come on a braided copper cable consisting of 72 fine
strands of wire. The heating units, or cells, consist of a
high-resistance wire wound on India mica, over which are
cemented a metal cover. The small units are then stitched
between two layers of heavy asbestos cloth. This asbestos
cloth is then covered with bags of either eiderdown or
cretonne, which can be easily removed for cleaning. Ex-
tra covers of waterproof material may also be had.
The pad is very flexible, light, and of a convenient size,
lOVa by 12y2 inches.
Electric Test -Tube Boiler
The boiler here illustrated consists of a small cylin-
drical drum, having a nickel-plated metal body with a top
and bottom of %-inch transite. The dimensions of this
drum are: height, 2V4 inches; diameter, ZV2 inches. The
apparatus is mounted upon three legs.
Located near the center of the drum there is a metal cup or
cylinder li'io inches in diameter and IVi inches in depth.
This is the heating receptacle. The cup is encased in a
resistance coil, which provides equal distribution of heat
to the entire surface of the receptacle simultaneously,
heating it uniformly and very quickly.
This resistance coil or heating unit is controlled by an
automatic electrothermo-regulator, contained within the
drum. It is adjusted by means of a small screw. To
reach the adjusting screw of the thermostat it is neces-
sary to use a small screwdriver. This prevents tampering.
The thermo-regulator completely controls the temper-
ature so that the contents of the test tube may be brought
to the boiling point without boiling over. Metal rings are
provided for the receptacle, permitting the use of the fol-
ing sizes of test tubes: % inch, % inch, % inch, and 1 inch.
An extra sterilizer attachment, consisting of a con-
tainer and wire basket, not illustrated, can be attached to
the top of the boiler. The wire basket is removed by means
of an adjustable wire tong, which fits into loops on the
wire basket. Similar loops are attached to the body of the
sterilizer, so that the entire apparatus may be easily re-
moved from heated receptacle.
test-tube boiler. Fig. 2, metal rings providing for the
sterilization of different sizes of test tubes.
A nest of four test tubes is furnished with the sterilizer,
largest one (1 inch in diameter) having a cork disc in the
bottom to protect the point of scalpel.
The above-described outfit, in connection with the elec-
tric test-tube boiler, makes an ideal small sterilizer for
hypodermic syringes and needles, probes, scalpels, etc.
Hot-Air Apparatus
A simple and inexpensive apparatus for the application
of dry air of a high temperature has been put on the mar-
ket by Codman & Shurtleff, Boston, Mass., under the name
of "Newell Hot-Air Apparatus." The apparatus is made
of sheet iron and lined with asbestos. The sleeves for in-
closing the arm, shoulder, leg, and hip are made of heavy
canvas. The apparatus rests on an iron frame, 19 inches
high, the height over all being 31% inches. The heat is
derived from a kerosene lamp which is supplied with the
outfit.
We are informed that a number of these apparatuses
have been in use for some time in the orthopedic depart-
ment of the Carney Hospital in Boston and the Johns
Hopkins Hospital in Baltimore, where they are giving
satisfactory results.
THE MODERN HOSPITAL
A Monthly Journal Devoted to the Building, Equipment, and
Administration of Hospitals, Sanatoriums, and Allied Institutions,
and to Their Medical, Surgical and .Yursing Services
Vol. XI
September, 1918
No.
|;»:,y.,;y:^"igyy'¥^;;s£^:^5::5^^'"yy^^^^ >j£SS^s-^ vv-^'Y,:
:►!>; =
A FRATERNAL INSTITUTION FOR THE FREE TREATMENT OF TUBERCULOSIS
Colorado Sanatorium Maintained by the Modern Woodmen of America for Free Treat-
ment of Tuberculosis Amon^ Members — Progressive Attitude of Society —
High Standard Maintained at the Sanatorium
By J. A. RUTLEDGE, M.D., Medical Direct.jr and Superintendent. Modern Woodmen of America Sanatorium,
Woodmen, Colo.
NESTLING at the foot of Mount Cedar, in the
heart of the Rockies, the society of Modern
Woodmen of America has built one of the grand-
est monuments to fraternalism that can be found
anywhere. The head officers, noting the many
deaths due to tuberculosis in their society, con-
ceived the idea of erecting and maintaining an
institution for the free
treatment of tubercu-
losis for its beneficiary
members.
After duly considering
this matter, a committee
was sent to investigate
the various locations
throughout the United
States, in order to secure
the best possible site for
a sanatorium ; and the
present location, which Fig. i.
is twelve miles north of
Colorado Springs, was selected. Nineteen hun-
dred acres of land were purchased, and the
little town of Woodmen is located there. The
population is composed entirely of the patients
and those employed by the society to carry on
this work.
The sanatorium was officially opened for busi-
ness on January 1, 1909, although at that time
the equipment was very small, consisting of only
a few tents and such wooden buildings as were
necessary for offices, kitchen, dining-rooms, and
living quarters for the help. Donations from the
various camps of the society and from individual
members assisted largely in defraying the ex-
penses in the early days of the sanatorium's ex-
istence. Later it was maintained on a budget sys-
tem from the head office, but at the head camp,
held in Toledo in June of 1914, the society voted
a special fund for the
maintenance of the insti-
tution. This fund is
raised by a levy of three
cents a month on each
member of the society;
and it is largely due to
this fund that the sana-
torium has arrived at
and maintained its pres-
ent high standard. Few
who visit the institution
can realize hov\' so great
a work could be accom-
plished in so short a time. The site for
the tent cottages was selected and two col-
onies were formed. At the same time pro-
vision was made to increase the capacity so as
to accommodate the greatest possible number of
patients. In each of these colonies a large utility
building was erected, and around these buildings
the tei.- cottages wei'e arranged, ninety in each
colony. The utility buildings each contained a
physician's office, recreation room, throat room,
baths and toilets. The cottages originally had the
of Amer'Ca
156
THE MODERN HOSPITAL
g s- g IT wv_>r ^in^-i larp"
< r^
jiving hospital, equipped with all the dij
canvas sides, were heated with stoves and lighted
by lamps. However, the sanatorium, after a few
years, installed a complete heating system ; the
cottages were heated by steam and equipped with
electric lights. The canvas has been replaced by
siding and the cottages have been completely
ceiled on the interior, until now they are modern
in every way.
Later a large administrative building was
erected, containing all of the quarters for execu-
tive offices, dining-rooms, kitchen, store rooms,
quarters for the female help, library, post office,
meat market, barber shop, etc. A home for the
(I
superintendent, cottages for the staff physicians
and accommodations for the other help have also
been added. Practically all the buildings have
been built of the native stone, gathered from the
mountains on the sanatorium's estate. A large
amount of the ground is now in cultivation, and
the institution owns a large herd of Holstein
cattle, thus being enabled to maintain its own
dairy.
Grading and parking was done, cement walks
laid, and the lawns made beautiful with flowers
and shrubs. Three large greenhouses are main-
tained, for the management appreciates the great
Fig. 3. The utility building, with a colony of cottages at one side.
THE MODERN HOSPITAL
157
therapeutic value which flowers have in an insti-
tution such as this.
Perhaps the greatest improvement the sanato-
rium has made is the erection of a new receiving
hospital, which has been in use a little more than
a year. This hospital is equipped with all the
devices that modern medical science has to offer
in the treatment of tuberculosis. The hospital
has a capacity of from fifty to sixty, so that now
from two hundred and fifteen to two hundred
and thirty patients are being treated at the sana-
Fig. 4. One of the individual cottages used by patients.
torium at all times. The hospital has complete
x-ray and dental departments, operating room,
and laboratories. A sun parlor has just been
completed on the top of the building, where
patients who are compelled to remain in the hos-
pital for any length of time may be taken for re-
creation and a social hour. Special rooms have
also been arranged for heliotherapy.
The superintendent recognizes the great neces-
sity for amusement of a light nature, consequently
picture shows are given every Friday evening
for the benefit of the patients, lectures by the
staff officers each week, and concerts and other
amusements are provided by entertainers from
Colorado Springs, for the pleasure of both patients
and employees. A library of some three thousand
volumes is maintained, so that the patients have
all the wholesome reading they need. They have
their own Sunday School every Sunday morning,
FiK. 5. A patient undergoing examination in the x-ray room.
and prayer services on Sunday evening. Twice
each month a minister comes to conduct Sunday
afternoon services, and on alternating Thursday
mornings a Catholic priest from the Springs holds
mass for the Catholic patients.
Dr. J. W. White was the first superintendent
and medical director of the institution, and he
had one assistant. In 1912 he was succeeded by
Dr. J. A. Rutledge, of Elgin, 111., who is still at
the head of the institution. As the sanatorium
enlarged, the need of more medical assistance be-
came greater, until now Dr. Rutledge has a staff
of four physicians and a dentist, and an adequate
nursing staff. In fact, the sanatorium has, in its
■various departments, a complete working force
of from one hundred and twenty-five to one hun-
dred and fifty.
Since January 1, 1909, to June 1, 1918, 3,820
patients have been treated at this institution.
This number, of course, includes those being
treated at the latter date. We have patients liv-
ing in all parts of the country, many of them
returning to lives of active business, and some
at this time defending the nation's honor in
France. Thorough treatment, including every
Fig. 6. The operating room at the Mode
America Sanatorium.
158
THE MODERN HOSPITAL
special medical attention one's condition may re-
quire, is given, but no patient is permitted to re-
main at the sanatorium for a period longer than
nine months.
The directors of the society and the medical
staff of the sanatorium realized that fighting
tuberculosis was a long, hard struggle, often a
matter of years, rather than months, and in order
to benefit the greatest number of the society's
members, it would be necessary to limit the time
for treatment, rather than to permit patients to
remain at the sanatorium indefinitely. They de-
cided to make the sanatorium more of an educa-
tional institution, teaching the patients how they
must live in order to prolong their own lives, and
also how to protect the lives of the people with
whom they associate, rendering the greatest as-
sistance toward eventually stamping out tuber-
culosis.
The patient who discovers his trouble early
is almost certain to obtain an arrest of his disease
if he comes to the sanatorium at that time. And
he is so grateful that he always has a good word
for the sanatorium and all connected with it. The
patients who come later, when their disease has
become far advanced, seldom receive much last-
ing benefit.
It is not wide of the mark to say that a sana-
torium is a success or a failure, just in the pro-
portion as the patients submit themselves for
treatment in early or late stages of the disease.
The patients with incipient cases go out in very
good condition, happy over the result of their
treatment, and with fair prospects to live their
allotted time. The far advanced patients, how-
ever, very often go home to die, and they and
their friends usually feel that sanatorium treat-
ment is at fault. The trouble lies not with the
sanatorium, or with the treatment, but at the door
of the patient who must remain at home a little
longer, to plant his crops, arrange his business
affairs, or for some other reason ; and in some
instances, we regret to say, the fault lies with
physicians who do not make the diagnosis soon
enough. Could these two defects be eliminated, the
work done at the Modern Woodmen of America
Sanatorium would be of even greater benefit to
the patients and to the society. The work is of
inestimable value, for there is no greater law
than "Love thy neighbor as thyself."
HOW THE AMERICAN RED CROSS IN FRANCE MENDS MUTILATED FACES
Mrs. Maynard Ladd, the Sculptor, Studies Men's Hearts and Gives Them Back Their
Features— Life-like Masks Made of Copper, Painted to Simulate
Natural Tones of Skin — Touching Gratitude
of Wounded Heroes
By KATHERINE DE MONCLOS, cf the American Red Cross.
UK MUSEUM of horrors"
jl\. which the hospital for
generally known in France,
seems a brutal one
at first, but when
one has been
through the wards
and seen for one-
self, no words can
be too strong to ex-
press the pitiful
hideousness of these
mutilated heroes.
They are a horror
to themselves, to
their families, and
to their friends,
and inevitably their
outlook on life has
been completely
is the name by
facial wounds is
The designation
changed, largely owing to their appearance. It is
a difficult problem to place them, and even the
public highways are forbidden to them unless
they continue wear-
ing a bandage to
; hide the gaping
hole, the absence of
a chin, or the loss
• of a nose.
In England Cap-
tain Derwent
Wood [whose work
was desci'ibed in
The Modern Hos-
pital, August, page
148], has, for some
time, been making
galvano -plastic
masks for these
cases. Having seen
Maynard Ladd at
THE MODERN HOSPITAL
159
and recognized the beautiful utility of this work,
Mr. Lewis Hind, an English art critic traveling in
America, went to see Mrs. Maynard Ladd, the
sculptor, in her studio on the North Shore out of
Boston. Her versatile talent, her great ability in
catching not only the resemblance but the life and
personality of her models at once inspired Mr.
Fi(r. 2. One of Mrs. Ladd's subjects
Hind with the suggestion that she should do for
France what Captain Wood is doing for England.
In December, 1917, she came to Paris, took a
studio, and started her work of healing hearts as
well as mending faces. Her work is done under
the direction of the American Red Cross in
France.
The man who was ashamed to be seen, who felt
his whole life must be spent hiding his hideous
wound, had a heart-ache which seemed incurable
until Mrs. Ladd offered to make him whole again
by replacing the lost face with a new and exact
reproduction of the old one. The transformation
is complete, for a new hope seems born with the
new face ; life once more opens its doors, and the
future seems alluringly hopeful to the man re-
stored almost to his former self; he need no
longer be a pariah.
Mrs. Ladd's work is almost life-like. When the
wound is sufficiently healed, she molds the face,
and, with the help of a pre-war photograph of
the patient, a portrait is modeled, completely hid-
ing the ravages of the wound. The men are great-
ly interested in the likeness, and long talks in her
studio are of great value to the artist, for they
not only help her to rectify the profile, which is
not always a perfect resemblance — sometimes the
nose must be lengthened or the chin slightly al-
tered— but also to gain their confidence. They
unconsciously reveal their hearts' very psychol-
ogy, by which means she is able to impart some-
thing of the former expression. The eye is the
keynote, and in many in.stances one or both must
be reproduced and the expression, whether gay,
pensive, tender, or energetic, is based largely on
the knowledge of the inner man which Mrs. Ladd
has managed to glean during her friendly chats.
When the molded resemblance is satisfactory,
a copper reproduction is made, which is dipped in
an electric bath, after which it is carefully ad-
justed before being silvered. Later it is coated
with Aspenwall's enamel and finally painted in
oil colors. This painting is no simple matter, for
it is treated in a peculiar way so as to obtain the
dull, slightly rough appearance of the skin. The
nostrils and mouth are open so as to permit
breathing, and, thanks to a special cigarette-
holder, the men can smoke as freely as before.
Where it is necessary to replace the ears, they
likewise are perforated so the hearing will not be
Fip. S. The compIeU.l wm,;.
hampered. Mustaches are sewn in. Artificial
eyes are not inserted, but false eyes are modeled
in plaster. A complete mask covering all the face
costs only eighteen dollars ; the half mask costs
nine dollars. Mrs. Ladd is taking nothing for her
services, which accounts for the low price at
which this artistic work has been established.
Owing to war difficulties, the work does not
progress very rapidly ; it takes about a month to
execute a complete mask. The mask is extremely
light and strong, is generally held on by means of
spectacles fastened back of the ears, and so firmly
and comfortably is it attached that the wearer
takes childish pleasure in pulling and stroking
160
THE MODERN HOSPITAL
his mustaches while sauntering down the street,
a cigarette between his lips. The illusion is pa-
thetically amusing.
The American Red Cross is having a certain
number of masks made at its expense. The first
hospital to order any — and it still shows a deep
interest in the work — is the French Military Hos-
pital, the Val de Grace. The Lariboisiere Hos-
pital and the Belgian and Mutile Hospitals at
Rennes have also recently appealed to Mrs. Ladd,
and mo.st of the surgeons are much interested in
the work. Dr. Tait McKenzie is .starting a de-
posit .school in Philadelphia; .so on all sides the
good work is spreading, and soon hundreds will
be able to profit by this pioneer movement.
The men are touchingly grateful. A tall hand-
some fellow came back to the studio after his
first outing, overjoyed ; it was the first time in
two years that he had not been stared at in the
streets in horror. Another good-looking country
lad, if one could l)elieve his former photograph,
laughed delightedly when the completed mask
was finally adjusted. "When I go home," he said,
"I'll have all the pretty village girls hanging
around my neck wanting to kiss me, I am so good-
looking!"
Mrs. Ladd has sculptured an infinitely touching
figure of one of these mutilated heroes. To her
he symbolizes the moral attitude of all who have
sought her help. He is kneeling, seated back on
his heels. His hanging upturned palms, seeming
to appeal for pity and assistance, the defeated
droop of the shoulders, the bowed head, as though
ashamed of showing the death mask, all that is
left of his former face, are a heart-breaking ap-
peal, and speak more eloquently than any words
of the hopelessness and sorrow which so often
accompany these disfiguring wounds.
HEALTH INSURANCE: ITS MEDICAL AND HOSPITAL ASPECTS*
Whtil l(.s iit'iiofits Reiilly Are— An Insurance Plan Which Penalizes Neglect and Rewards
Prudence Prevention a Function of Social Insurance
By .JOHN A. LAPP, Director of Investigations, Hkaltii and Old Age Insurance Commission of Ohio
AMONG the major hazards of life, sickness is
one of the most important. Indeed, it would
be voted as the most important hazard by any
group of people. "If I can keep my health, I am
all right," is heard on every side from those who
toil for a living. The misery in the home of the
people of meager means, when disabling sickness
enters, is beyond description. It need not be de-
scribed, however, because everyone has seen it. A
sort of fatalism possesses most people, and their
fear of disease is expressed in their hopes that
they may be spared. Yet they know that, un-
erringly, a certain number are doomed to sickness
and death every year, every day, and every hour,
and it is only a que.stion as to whose turn is next.
So unerring is the law of sickness and death that
we can tell, almost to an exactitude, how many
people will die next year, and about as exactly how
many will be sick, and for how long a time.
Sickness leaves in its train a variety of conse-
quences besides its major consequence — death. A
part of the afflicted are disabled permanently and
• incapacitated from earning a living. Another
part are partially disabled and thus physically
handicapped. Another part are handicapped
economically by the cost of sickness and the loss
of earnings. A large number are driven to de-
pendence by their unpreparedness for a severe
'Read nt the Fourth Aiinuul McctiiiK of the Ohio Hospital Association
Columbus.
sickness and by the consequent necessity of rely-
ing first upon relatives, then upon friends, and
finally upon the public. Any one of these conse-
quences may happen to almost any person. Even
the accumulation of a "nest egg for a rainy day"
will not suffice to save the most thrifty from the
hazard. A man who may be considered well-to-do
in the world's goods, may, as a result of a single
prolonged sickness, be placed in a position of
economic dependence. Not one per cent of the
people of Ohio are possessed of enough property
to insure them against dependency, if they .should
be stricken with a prolonged disabling sickness.
Under such circumstances, life is a gamble, and
the stakes are nothing short of all we hold dear.
We do not even have the privilege of throwing the
dice. We cannot even verify the result, and from
the verdict there is no appeal. We accept the
consequences and call it fate.
Fourteen in every thousand of Ohio's popula-
tion, or about 70,000 in all, will die this year.
From 2.5 to 3 per cent of the total population
will be seriously sick at all times, or 125,000 to
150,000 people, and the number of difi'erent per-
sons who will be sick will number from 2,000,000
to 2,500,000. Those who are sick, roughly speak-
ing, will average about eighteen to twenty days'
of disability. Of the 125,000 to 150.000 who are
sick at all times, about 12,000 to 15,000 will be
sick for less than seven days, while from 60,000
THE MODERN HOSPITAL
161
to 75,000 will be sick more than three months,
and this excludes the dependents in county in-
firmaries and state institutions. There are. today,
in Ohio, fully 25,000 people, outside of charitable
institutions, who have been sick for more than
three years.
Facts such as these were the reasons which im-
pelled the last General Assembly of Ohio to create
a special commission to investigate the causes of
sickness, and to determine whether a plan of
health insui'ance could be organized, under state
auspices, which would distribute the cost of sick-
ness, eliminate so far as possible the gamble of
life, and thus stabilize society. The commission
has been at work for several months in an earnest
effort to find out the facts about the extent of sick-
ness which are needed as a basis for an under-
standing of the problem and for constructive
proposals to solve it.
First : To begin with, a commission of this
kind should determine whether or not there is
a condition demanding legislative action. If the
commission finds there is not such a condition,
then it should proceed no further, for it is unwise
to attempt to cure non-existent ills by placing
unnecessary laws upon the statute books.
If the commission finds the conditions do de-
mand correction, then it should measure and con-
sider what the actual conditions are. The very
fact that a commission is created for the study
of a subject presupposes that enough information
is at hand to show that conditions demand action,
or, at least, warrant action for the public wel-
fare. It is hardly conceivable that the legislature
would create a commission to study a subject and
provide any considerable appropriation therefor,
unless there are conditions which are so evident
as to warrant the expenditure, and unless the
problem is so difiicult as to require the services of
a special commission. We must assume, then,
that the evidence would warrant the conclusion
that a definite need is presented.
Second : Having measured and considered the
existing need for legislation or action of some
kind, the commission's next step is logically to
determine what existing laws or agencies there
are already to meet the needs, and how well they
are meeting them. They must go further and see
whether the existing laws and agencies may not
be so corrected, revised, or enlarged as to meet
the needs. If this is done, and it appears that
present laws and agencies cannot be made ade-
quate, then the next step logically follows :
Third: Remembering that "there is nothing
that is new under the sun," the commission will
tn,^ to determine what other states and other coun-
tries have done to meet similar conditions, for it
is very certain that no subjects are proposed in
modern legislation which have not somewhere re-
ceived legislative attention. Legislative investi-
gators will tell you that they scarcely ever have a
proposal without some precedent. Andrew
Carnegie once said that his company had lost
many millions of dollars by undertaking things
without first knowing the whole experience of the
industry on that subject throughout the world. It
is very safe to say that the people of the states
have spent billions in unwise experiments which
could easily have been prevented by attention to
established facts.
Fourth: Along with a study of legislative ex-
perience goes the collection of information, data,
and opinions expressed by publicists and adminis-
trators, so that the actual operation of laws and
their administration may be fully and carefully
weighed. It is unnecessary to say that the mere
presence of laws upon the statute books does not
indicate that they are accomplishing what they
were designed to accomplish. Nothing but a study
of administrative experience under such laws will
warrant final conclusions.
Fifth: A study of administrative experience
is essential also in determining how any proposed
plan will fit the local conditions and the machinery
of administration in the state in which it is to be
put in force. Detailed studies are extremely im-
portant. The very last point of administration
must be determined, or else the structure, other-
wise admirable, may not stand the test on account
of defects in detail.
Sixth : If legislation is proposed and costs in-
volved, it is very important that the extent of costs
and the source from which the money is to come
should be determined. In general, the question
of costs must be considered (because it is a prac-
tical problem) ; yet, actually, when the evidence
shows that a thing must be done to meet an
established social need, this side of the question
must, to a certain degree, be shoved into the back-
ground, because society must do the thing for
which it is responsible, regardless of cost.
Seventh : Commissions naturally desire to see
their work result in some action. Non-action con-
demns the fruits of their investigations. If, after
studying a subject for two years, it is the plain
and clear conclusion of a commission that condi-
tions cry out for action, and the legislature should
then fail to enact laws to meet those conditions,
the commission must consider that its conclusions
have not been so well founded as they supposed, or
else that it has not been able to express them con-
vincingly enough to cau.se action to be taken.
Probably one of the greatest sources of weakness
and causes of failure in the work of the legislative
162
THE MODERN HOSPITAL
commissions is that proposals are not worked out
in final details in the form of legislative bills. The
framing of the bill to carry out exhaustive and
detailed recommendations is the most difficult of
all the processes, and failure to prepare the bill
leaves a burden upon the legislature which it is
unlikely to perform as thoroughly as if the definite
bill is laid before them for consideration.
The Ohio commission has approached the
problem with unanimity of opinion on one point,
namely, that the problems entrusted to it are the
most important which have ever been considered
by a commission or by an American legislature.
Naturally, therefore, there has been an unanimity
of opinion that no effort should be spared to un-
cover all of the facts and present them without
bias. I can speak truly for the commission that
not a single member would favor action of any
kind which did not find support in the facts dis-
closed. The members realize that the issue is too
important, and the consequences too vital to the
social and economic welfare of the state, to war-
rant action upon anything less than the whole
truth.
Health insurance should provide two main
benefits to cover the corresponding hazard :
1. Cash benefits to be paid during disability.
2. Medical benefits, including care by physi-
cians, nurses, hospitals and dispensaries, and the
cost of medicines.
Both of these elements are essential to any
adequate solution of health insurance, but, if one
is more essential than the other, that one is medi-
cal benefits. The commission finds that in exist-
ing health insurance in the state, cash benefits are
provided for to some extent, the prevailing benefit
being from $5 to $7 a week, while complete medi-
cal benefits are almost unknown. Even the cash
benefits stop at the end of thirteen to twenty-six
weeks, in most cases.
Now, if health insurance is to be real insurance,
it must cover the whole risk, and be for the whole
time. Mere insurance, of a fraction of the wages
of a man for twenty-six weeks, will not insure that
man against the hazard of sickness. To be really
insured, a man must be secured against the loss
of, at lea.st, a large part of his wages during the
entire time of his disability, and also against the
cost of adequate medical care, whether that cost
be ten dollars or ten hundred dollars. The real
cost of a serious and prolonged sickness is more
in the medical, hospital, and nursing care than
in the loss of wages, although the loss of wages
must not be overlooked by any means.
Let us see what happens in cases of sickness in
typical homes.
A. A man with a family of four, earning $18
a week and insured for $7 a week, with no medical
benefit, is taken sick with typhoid fever. The man
has no savings. If there is a city or charity hos-
pital, the man may accept public relief and be
cared for in the hospital. If there is no such
hospital, or if the man desires to be independent
of relief, a physician is employed to care for him
in the home, or the hospital takes him as a pay
patient. If he pays either for hospital care or
home doctoring, he will find that, at the end of
his sickness, he has a debt for medical care
which he cannot hope to pay out of $18 a week.
In the meantime, his family has been compelled
to pay rent and live on $7 a week, as against a
normal $18 a week. Even if medical care is given
free in a hospital, the man will still find a debt,
for the necessaries of life for his family are so
large that he cannot but be discouraged to face
his old problems of living and his new problems
of paying a just debt on $18 a week. He is apt
to leave the hospital and return to work before
he should, and a relapse may bring him back, to
add new burdens and to sink him deeper in debt.
Meanwhile, the worries for the future hinder his
return to health. This man has been weakened,
economically to the breaking point, if, indeed, he
is not broken. Another sickness in his family will
compel him to ask for charity.
B. This man has a wife and two children,
earns $22 a week, and owns a home worth $3,000,
which he has paid for by the savings of fifteen
years. He has health insurance of $9 a week in a
fraternal order, for a period of thirteen weeks'
disability. He is stricken with a disease which
lays him up for six months and requires the con-
stant care of a nurse and two visits a day from the
physician. If he pays his bill at the regular rates
and the deficit in the family income, he will be in
debt upwards of possibly $2,000. His home may
be sacrificed, or he may spend fifteen years more
in saving to make up the deficit. Another pro-
longed illness, and even this thrifty man, who had
saved $3,000, would have to ask the public for
relief.
C. This case is similar to Case B, but this man
had $10,000 in property, and no insurance. A
partial stroke of paralysis rendered him practi-
cally helpless for ten years, and required constant
medical care. His entire fortune was spent, and,
in his weakened condition, he had to begin life
ever.
Let us now assume a case under a health insur-
ance plan which provided adequate medical care
and gave cash benefits. A man with a family of
three has savings of $1,000. He is taken sick with
a puzzling malady. The home doctor is uncertain,
and has the case given to a local hospital. The
THE MODERN HOSPITAL
163
hospital doctors give the case a searching diag-
nosis, and find that an operation of great delicacy
must be performed. The patient is removed to
one of the leading hospitals of the state, and the
operation is performed by an eminent specialist.
The patient slowly recovers, and in six months'
time is finally restored to health. But what has
happened in the meantime to his economic status ?
The sickness insurance has been nearly enough to
pay the living expenses of the family. They have
drawn upon the savings to the extent of $100.
There are no doctor bills, and the man begins life
almost where he left off, with no great economic
handicap. If he had not had the cash benefit he
would still have $500 of his savings left, but if he
had not had the medical benefits he would either
have died from inability to purchase what he
needed or he would have been behind not less than
$2,000, when he was again ready to go to work.
The point in these cases is not to prove the
value or necessity of health insurance, but, rather,
to point out the relative importance of medical
benefits, including complete hospital care and
treatment. At present, in some parts of the state,
such care is available to the poor who accept it
as a charity ; to the semi-poor who accept it as a
semi-charity — a part-pay proposition ; and to the
well-to-do who pay liberally for it. In other parts
of the state, such care is available to neither the
rich nor the poor, and facilities are not available
to bring patients from smaller places to the cen-
ters where hospital facilities abound.
If the foregoing appears as an argument for
health insurance, it should be remembered that
no one doubts the value of such insurance. It
is accepted and approved by all people, just as fire,
life, and accident insurance are accepted and ap-
proved by all. The only question at issue is
whether health insurance can be and should be
organized by the state on a universal compulsoiy
"basis. That is the question which the Ohio com-
mission considers its duty to solve. The Ohio
commission is prepared to express no opinion at
this time, but, in conformity with its policy of
open discussion, it is frank to say that any plan
of health insurance, to get its approval, must
provide adequately for medical and hospital care,
so as to cover the whole risk, and for the fullest
possible development of preventive measures.
To all persons who are impressed by the evi-
dences of ill health and disability, as disclosed by
the figures of the first draft, by the partial sick-
ness surveys which have been made, or by com-
mon observation, it must appear that correction
and prevention are of the first importance. We
do not know exactly what part of the disabilities,
as shown bv the draft, could have been or could
now be corrected, nor do we know exactly what
part of the average daily sickness could be pre-
vented, but we do know that, in each case, the per-
centage is very high.
The relation, therefore, of health insurance to
sickness prevention needs the most careful study.
If health insurance will provide for the cost of
adequate medical, hospital, and nursing care,
while at the same time tiding the individual over
the loss of wages, then corrective and preventive
measures can be applied. If health insurance will
not fit into the scheme of prevention, then the
argument for it as a social measure is weakenect.
Prevention can best be accomplished in an in-
surance plan by putting a money premium upon
it. The city or town which fails to promote the
health of its people should be charged extra for
its neglect ; the industry which weakens the
vitality of its workers by insanitary conditions,
should be penalized ; and the worker who dopes
himself with drugs or liquor should get smaller
benefits or pay an extra price. On the positive
side, a premium should be placed upon approved
conditions in factories and in cities, to the end
that if minimum health standards are maintained,
or if preventive measures, medical care, and other
facilities are furnished, a reduction will be
made in the cost. Good sanitary conditions in in-
dustries and municipalities should be rewarded,
as well as bad ones penalized. Trade unions,
fraternal societies, and establishment funds should
be encouraged to reduce as far as possible, the
burden of preventable sickness.
The state is concerned primarily with the whole
social cost of insurance. That cost is the total
loss from sickness, and not merely the amount
paid out for losses. The social motive added to
the economic motive makes prevention a funda-
mental in health insurance by the state. Health
insurance by private companies is not concerned
as a business proposition with the prevention of
disease. It measures the probable loss from sick-
ness, and fi.xes its premium accordingly. State
health insurance, on the other hand, should pre-
vent all preventable sickness as a social policy, and
health insurance organized by the state should
provide the most complete plan for the preven-
tion of disease. As a social institution, the state
cannot do less, because, to quote that great medi-
cal leader Dr. Victor Vaughn, "That government
is the best which secures for its citizens the great-
est freedom from disease, the highest degree of
health, and the longest life, and that people which
most fully secures the enjoyment of these things
will dominate the world."
Prevention is not a function of insurance when
conducted by private corporations. It is a func-
164
THE MODERN HOSPITAL
tion of any plan of social insurance. Private fire,
life and accident insurance companies disti'ibute
losses, but do not necessarily prevent them. The
more the losses, the higher the rates. It is merely
a matter of adjustment of rates to losses. The
state and other carriers of insurance, under a
state social insurance plan, should be encouraged
to develop preventive measures. The commission
is asking that the best thought of the state under-
take to help make prevention of disease effective,
if some plan of social health insurance should be
approved by it.
On the corrective side, a great new movement
is in progress as a result of our awakening due
to the war. We have come to appreciate the value
of man-power and to give a thought to human
salvage. We are taking steps to rehabilitate the
wounded and disabled soldiers and return them to
self-support and independence, and perforce
we shall inevitably turn our attention to the men
who are handicapped in industry by accident and
disease. We have seen the handicapped man on
the street, in the factories, in almshouses, every-
where, but we have not seemed to realize that he
constitutes one of the greatest social problems for
democracy to solve, namely, the removal of the
handicap, so far as it may be removed, and the
refitting of the man to take his place in the world's
work.
Suddenly, when the war was precipitated, we
began to think what should be done for the men
who suffer physical handicaps as the result of
wounds or disease in the army.
Our neighbor, Canada, offered examples of the
solution of the problem. Her rehabilitation work
had been done to remove, as far as possible, the
physical handicaps of the returned men, and to
fit them vocationally for effective labor. Our ex-
perts visited Canada, saw the results, and came
back enthusiastic over the program for physical
and vocational rehabilitation of wounded soldiers.
A bill is now pending in Congress, with every cer-
tainty of passing, making a large appropriation of
money for the conduct of the work. It is a great
humanitarian and socially constructive movement.
But the question is asked, "Why confine it to the
soldiers of the field and not make the same prin-
ciple apply to the soldiers of industry who are
wounded and crippled by the thousands in the fac-
tories, or on the streets of our country?" It is
strange indeed that we have not thought of the
problem before, but we are fortunate now in at
least having the naked truth before us and in hav-
ing examples of the solution of similar problems
right at hand.
No action is likely to be taken by Congress at
this time, with reference to industrial cripples.
but their rehabilitation is bound to follow in the
wake of the rehabilitation work among the
soldiers. It ought to have been adopted in the
states as a part of the Workmen's Compensation
Acts, but it was not, and serious consequences
have followed. No system of workmen's com-
pensation can be permanently successful as a
social institution without adequate rehabilitation
work, and no health insurance plan can ever be
successful as a social institution, unless provision
is made for the men who are handicapped by
illness or physical defects. In this work the hos-
pitals must play the largest and most important
part.
It appears, from the foregoing suggestions and
facts, that the rehabilitation work now in prog-
ress and in prospect will place new and, I take
it, altogether acceptable duties upon the hospitals.
Health insurance would bring further needs for
the hospitals to meet, and, at any rate, the preven-
tive and corrective measures which are bound to
come, either with or without health insurance,
make necessary the expansion of hospital facili-
ties. It is probable that, owing to lack of organiza-
tion to serve all classes, not one-half of those who
need hospital treatment actually go to hospitals,
even in cities where ample facilities are at present
furnished. If the whole state were properly pro-
vided with hospital and dispensary facilities, prop-
erly organized, there would be fully four times as
many cases cared for as at present. Health in-
surance would, of course, greatly increase the
demand.
How to organize a state-wide hospital service
is a problem which needs to be carefully consid-
ered, whether health insurance is provided or not.
I am indebted to Dr. A. R. Warner, of the Ohio
commission, for the suggestion — which I hope he
will elaborate further — that state hospital facili-
ties might be organized on the plan of the
military hospitals in the war. At every county-
seat, or at the population center of each county,
there should be an emergency hospital with dis-
pensary and ambulance facilities of sufficient
equipment to give emergency relief, or, if possible,
to take care of the less serious cases, and espe-
cially of maternity cases. There is surely no
county in the state which cannot provide this
minimum. At the larger centers the base hos-
pitals are provided, to which patients needing
more extended treatment are removed. At the
centers of population, where hospital facilities
already abound, there would be the splendid hos-
pitals in which difficult diagnoses could be made
and delicate operations performed, or treatment
given. Dispensaries and clinics could readily be
furnished locally and at the base hospitals. Under
THE MODERN HOSPITAL
this plan, a person taken sick in the remote coun-
try town has the chance, if he desires it, to obtain
the best medical and hospital care which the state
affords, within his reach. Under a health insur-
ance plan which carries the whole risk this would
165
be given to the insured, in the language of the
jurist, "freely and without purchase, completely
and without denial, speedily and without delay,"
the service being paid for out of the insurance
funds.
HOW TO BLILD AN EFFICIENT GENERAL HOSPITAL FOR A SMALL COMMUNITY
A Typical American City of Four Thousand-How Brookville is Solving Us Hospital
Problem— Some of the Questions To Be Asked Before Planning a Hospital
By emmet E. bailey, Architect, Pittsburgh, Pa.
THE Brookville General Hospital is to be built
in a tjTDical small city of about four thousand
people. Among the industrial activities of the
community are manufacturing and mining.
There are two railroads running through Brook-
ville, and it is surrounded by a good farming
country. So it will be seen that there is nothing
unusual about the place, and whatever would
apply to Brookville would apply to the average
town of its size anywhere. I think it is true that
that board of trustees are a little above the aver-
age board of trustees, in both harmony and gen-
eral business ability, the value of which is obvious
in a new building project. So far as the place
itself is concerned, its people are afflicted with
the usual ills that flesh is heir to, with about an
average proportion of each. The solution of the
hospital problem in Brookville, therefore, should
help to answer the question how to build a com-
plete, modern, efficient, general hospital in a city
of four thousand with the money available.
In the first place, the cubic foot costs for all
buildings of a certain class are fairlj^ uniform,
with some variations according to locality. I am
a firm believer in fireproof hospital buildings, sim-
ple in design and with an interior detail specially
•suited for hospital buildings. I am convinced
that such a building will cost not less than thirty-
five cents a cubic foot. Now, if we have say forty
thousand dollars to spend on the building, com-
plete, it means that the building must not contain
over 114,000 cubic feet. We must remember that
every one of those 114,000 cubic feet cost thirty-
five cents and must not be wasted, but every foot
must be placed where it will be doing full duty all
the time. If the building is a two-story building
with a ten-foot ground story, it will probably be
thirty-one feet high, which means that we must
confine ourselves to not over thirty-eight hundred
square feet of ground.
In the next place there are at least three classes
of citizens vitally interested in the building of a
general hospital building, viz: — physicians.
nurses, and the public. The physician is entitled
to an institution, including the building, which
lends itself in every way to his work of ministra-
tion to the afflicted. The nurse is entitled to a
plant so arranged and equipped as to conserve
every ounce of energy possible, consistent with
efficient service, to the end that the patient may
be better cared for and the nurse enabled to con-
tinue the service. The public is entitled to an in-
stitution that never says no to a sufferer. If,
in the effoi't to keep the cost down, any one of
these three interests is neglected, the institution
will never be able to do the efficient work that
it ought to do, for it will be out of balance.
In my investigations of general hospitals, I
have sought to learn of the things in use which
were not spoken of at all, realizing that it is
the shoe that hurts which attracts most attention.
There are things, of course, that jump up and
slap you in the face, as you enter the building,
which are radically wrong. There are also those
features being used in almost eveiy hospital which
are filling their place after a fashion, but which,
like the shoe that hui'ts, cause a limp in the work,
and for that reason are thought of more than
some other features of the building, which are so
harmonious in their appointed functions that they
are not noticed at all.
I believe that the study of a general hospital
should be started by first scheduling and charting
the entire service, forgetting, for the time, that
there are any limitations in money, and listing
everything that would unquestionably conti'ibute
to the work of an institution of this kind. When
every room is listed and the work to be done in it,
its size and approximate location are charted,
then start the drawings. If the matter has been
studied thoroughly, in preparing the list and
schedule of requirements, about the first thing
discovered when work on the drawings is begun,
is that there are about three times as many re-
quirements as it is possible for the building to
accommodate. This should offer no discourage-
166
THE MODERN HOSPITAL
ment whatever, for it is a sign that we are on
the right track and, so far as it goes, is an indica-
tion that the effort will result in a building con-
taining a minimum of "misfits" and "forgotten"
features. From this point on it is a process of
"boiling down," never forgetting that, in com-
bining several rooms in one, provision must be
made for the work in the one that would other-
wise have been done in several rooms. It must
questions on this list for the purpose of illustrat-
ing the method :
1. May patients be taken fi'om the ambulance
to the delivery room or to the operating room
without going past wards or private rooms?
2. Is the lighting in the operating room from
the north or from above?
3. What provision is made for bathing and
examination of incoming patients?
Fig. 1. FilEt floor plan of the Brookville General Hospital.
ever be borne in mind that, while the number of
patients in a small hospital is less than that in
the large hospital, nevertheless, the variety of
ailments, generally speaking, is all there, and, as
I have said, each building must be so studied that
it develops a maximum of efficiency, both for the
physicians and for the nurses, in the work of re-
lieving and caring for these patients.
In developing the General Hospital for Brook-
ville, floor plans of which are shown, we prepared
a list of questions which were to be satisfactorily
answered by the plan. I will give a few of the
4. Is there an isolation room for suspicious
cases?
5. Is there a sound-proof room for delirious
patients ?
6. Is provision made for isolation of venereal
diseases?
7. What provision is made for care of patients'
clothing?
8. Where will the food for convalescent pa-
tients be prepared and served?
9. Is there room provided for distinct service
for obstetrical cases?
THE MODERN HOSPITAL
167
10. Is space provided for nurses' office?
11. Is there a convenient place for a blanket
warmer provided?
12. Are there service rooms, equipment and
utility closets?
13. Is there sufficient space for linen storage?
17. Have the doctors a consulting room near
the reception room?
18. Is space for x-ray rooms ample?
19. Are provisions made for a laboratoi-y and
drug storage on the ground floor?
20. Are diet kitchens so situated that food can
Ground Iloor and second floor plans of Brookville General Hospital.
14. Are provisions made for a lecture and dem-
onstration room for student nurses?
15. Is a silent signal call system provided for?
16. Is there a private telephone booth on each
floor convenient for visitors and nurses ?
be prepared in the main kitchen and taken to the
diet kitchens in the dumb waiter?
21. Does the equipment include provision for
an incinerator and a disinfecting room?
22. Should an emergency patient require atten-
168
THE MODERN HOSPITAL
tion when both the operating and maternity
rooms are in use, where will such a patient be
taken?
23. Is there an autopsy room located on the
ground floor in suitable place?
24. Is there a place in the basement where ap-
paratus can be stored, when not in use, and where
it can be repaired?
25. Is the sun porch sufficiently large, and is
it on the south side of the building?
26. May patients occupy private rooms and use
the sun porch at the same time that ward patients
do and be entirely separate?
27. How are patients to be conveyed from floor
to floor?
28. May a bed be taken out of one room, run
along the corridor and into another room without
difficulty?
29. Is there a place in every private room for
a bed without placing it in front of a window?
30. May the building be properly ventilated
without exposing patients to a draft?
I am fully aware that much has yet to be
learned about planning a small hospital before a
perfect one can be built, but I believe we have in
this structure eliminated at least some of the mis-
takes common in small hospitals. The exterior of
the Brookville Hospital is stucco on hollow tile.
The floor construction is hollow tile with concrete
joists. It is plastered with lime and sand plaster,
principally because this produces a more nearly
sound-proof building than hard wall plaster does.
The flooring in all the corridors, operating rooms,
kitchens, and bathrooms, is mai'bleoid with a sani-
tary base. All angles at the ceiling line are
formed with a cove. All windows are provided
with anti-draft side pivots and are hung on brass
chains and weights. The building is heated with
a two-pipe, vacu-vapor, modulating system. In-
clines are used throughout the building instead
of stairs.
The nurses are housed in a separate building,
wliich was formerly a dwelling. This has been
purchased by the board of trustees and will be
prepared for the nurses' use.
I can not express myself too strongly on the
importance of beginning preparations for a small
hospital by first considering every possible con-
venience, so many of them, that if all these needed
conveniences were installed, the building would
cost four times as much as the available funds
would provide. When this is done and the build-
ing "boiled down," remembering the doctors, the
nurses, and the public equally, we usually have
pretty nearly every exigency provided for, and,
while one room may be called upon to serve for
three or four rooms, everything has been thought
of. Then, if we don't fool ourselves as to cost, but
act on our good judgment instead, and bring the
building down to a size where we know it can
be built for the means available, we shall be sur-
prised and pleased to note what can be accom-
plished even in these strenuous war times. If,
on the other hand, we do fool ourselves, and take
a chance, thinking that perhaps we can get under
the wire with the cost, then find we can not, and,
to get the job to go ahead, make some radical and
unreasonable cuts, we simply destroy the sym-
metry of the plant and impair its usefulness for
all time.
If there ever was a time for serious thought
and profound study on the part of those design-
ing and planning small hospitals for such com-
munities as I have suggested, it is now. So many
physicians and nurses and other employees are
going into the service, and so many wounded men
will be returning from the service, that means
for the treatment of all kinds of cases in hospitals
must receive much more attention than it has
ever received in the past. The time has come
when the energy of the physician must be con-
served and provisions made for making the most
of his time.
Red Cross Work in India
"Following the example of the parent order, the St.
John Ambulance Association in India affiliated itself
in August, 1916, to the Joint War Committee in England
under the title of the Indian Branch of the Joint War
Committee of the Order of St. John and the British Red
Cross Society. Whilst leaving untouched the civil side
of the St. John Ambulance Association, the amalgamation
has promoted efficiency as regards Red Cross work, as the
first annual report of the activities of the Indian com-
mittee testified. Six hundred and foi'ty-five nurses and
nursing orderlies have been provided, while a further
demand for one hundred nurses is being met. A total of
113 motor ambulances, charabancs, and touring cars has
been supplied, and 22 launches for Mesopotamia, including
two mobile laboratories, one of which is fitted with special
bacteriological equipment. The committee also under-
takes the upkeep of the Lady Chelmsford Special Red
Cross X-Ray and Electro-therapeutic Hospital at Dehra
Dun. Red Cross representatives have been appointed at
the headquarters of each division, divisional area, and
independent brigade in order that the demands for Red
Cross comforts may be readily complied with, and mili-
tai'y hospitals are now as far as possible supplied by the
local working centers instead of having to rely on the Red
Cross depot at Bombay for their requirements. The
various Red Cross organizations throughout India, includ-
ing Burma, have been for the most part amalgamated
with the Joint War Committee, and are now working in
conjunction with it." — Lancet.
"The great p'int about gittin' on in life is bein' able to
cope with your head-winds. Any fool can run before a
fair breeze, but I tell ye a good seaman is one that gets
the best out o' his disadvantages." — Sarah Orne Jewett.
THE MODERN HOSPITAL
SOME PROBLEMS OF HOSPITAL MANAGEMENT
169
Louisville City Hospital Solves the Intern Problem by Employinti Senior Students-
Venereal Clinics Held with Active Assistance of United States Public Health
Service Affiliation of Large and Small Hospitals Desirable in
Training Nurses- Splendid Work in Conservation
By henry ENOS TULEY, M.D., F.A.C.P., Superintendent, Louisville City Hospital, Louisville, Ky.
'T^HAT the ideal hospital is the teaching hospital
is conceded by all leading authorities in hos-
pital management. The following reasons, ad-
vanced by Dr. Harold C. Goodwin, superintendent
of the Albany Hospital," sum up the advantages of
a teaching hospital : first, to the patient, because
of the complete equipment such a plant provides ;
second, to the attending men, who must keep to
the front or be superseded ; third, to the interns,
who are fortunate enough to secure an appoint-
ment; fourth, to the student body, which is
allowed the freedom of the hospital ; fifth, to the
training-school for nurses, which always has be-
fore it the examples of well-trained men doing
careful work; sixth, to the surrounding com-
munity, which, as a result, has a higher standard
of practicing physicians in its midst; seventh, to
the physicians in the surrounding country, who
are able to see, in consultation and otherwise, the
best men in their respective specialties ; and
eighth, to science, because in the teaching hos-
pitals new therapeutic and diagnostic methods
can be studied, bj' means of its trained clinicians
and laboratory workers, which can not be done in
the non-teaching hospital, since the latter has
neither the properly qualified staff nor the equip-
ment.
Hospital administration may be subdivided for
consideration into (1) administration proper;
(2) engineering; (3) intern stafif; (4) nursing;
(5) laboratory; (6) laundry; (7) kitchen; (8)
bakery; (9) housekeeping; (10) out-patient de-
partment; (11) visiting staff.
I. ADMINISTRATION
This includes statistical department, account-
ing, pay roll, supply requisitions, telephones, and
information.
The average visitor to the hospital has but
little conception of the details in the office of the
large general hospital. Here are grouped the
daily statistical reports, admissions, discharges,
and deaths. Vital statistics must be made to con-
form to the International List of Causes of Death,
or they are returned by the Census Bureau for
modification or amplification. A complete cross-
index system of causes of death will shortly be
installed in order that the statistics of the hos-
'The Modern Hospital. January. 191S, p. 33
pital may be readily available. Here all histories
are assembled and the many which are incom-
plete are returned to the intern for completion
of histories and physical findings. Day-books in
all departments must be carefully kept for the
pay roll, which is made twice each month. The
present administration in many city departments
has arranged weekly payment of wages, thus
doing away with the claim shaving in vogue for
so many years whereby 5 percent was paid to
private brokers who advanced money for wages
before the city pay rolls were authorized. The
supply pay roll must be carefully audited, bills
checked and attached to duplicate requisitions,
and the totals must agree with the city buyer's
office and the Board of Public Safety. The tele-
phone board must be carefully, intelligently, and
courteously attended, and ambulance calls prop-
erly scheduled and recorded. An average of
1,200 calls are received daily over the telephones
— inquiries regarding patients, staff calls, house
messages, etc.
The present bookkeeping system of the hos-
pital is not at all satisfactory, as the various sub-
divisions of accounts do not give suflicient details
of cost to be of value in keeping an accurate de-
partmental cost. These can well be divided into
the following ledger accounts.
1. Ambulance: Gasoline, supplies, oil, repairs.
2. Bakery: Flour, yeast, coke, supplies.
3. Drug Store : Medical supplies, serum, alco-
hol, wines and liquors, cotton and adhesive, sup-
plies.
4. Grocery: Fresh meats, lard and smoked
meats, butter, sugar, tea and coffee, cereals, con-
diments, milk and cream, eggs, fresh meats,
canned and fresh fruits, fresh vegetables, canned
and dried vegetables, groceries, miscellaneous.
5. Housekeeping: Brooms and mops, buckets,
soap, scrubbing powder, supplies.
6. Laboratory.
7. Laundry: Soap, starch, washing powder,
washing soda, supplies, repairs.
8. Matron: China and glassware, linen, rub-
ber goods, thermometers, surgical dressings, hos-
pital supplies.
9. Operating Room: Ether, gas and oxygen,
catgut, etc., supplies, repairs.
170
THE MODERN HOSPITAL
10. Office: Printing, stationery, telephone,
miscellaneous.
11. Power House: Fuel, light, oil and grease,
gas, machine supplies, repairs, ice plant.
12. Repairs to Building: Hardware, plumb-
ing, carpenter supplies, painter supplies, plaster.
13. Training School for Nurses.
14. X-Ray.
15. Miscellaneous.
16. Permanent Improvements : Buildings, bet-
terments, furniture and fixtures, automobiles.
II. ENGINEERING
This includes maintenance of the power plant
in the most economical manner, handling and
storing of coal, light, heat, and sterilizing plants,
ice manufacture, and repairs.
The engineering department might be con-
sidered the heart of the hospital. The economical
running of this department is essential. Abnor-
mal cost of coal, such as was experienced during
the past winter, makes it impossible to operate
the hospital within the estimated cost of the
annual appropriation. One item alone for the
hospital, coal, from September 1, 1916, to March
1, 1917, cost the city §8,923.26, and for the same
period of time in 1917-18 amounted to $22,946.02.
Because of the dirty boilers and the greatly in-
ferior quality of coal delivered, a much larger
quantity was consumed. The question of pre-
vention of smoke from our boilers is being
studied, as it is impossible for the city consistently
to demand smoke abatement of manufacturing
and other plants if its own institutions do not
prevent it. The architects of the hospital erected
a wonderful modern hospital building, but put up
a building for housing the power plant many
years behind the times. Coal has to be handled
three times before it can be put in the furnaces,
adding twenty-five cents a ton to the cost of the
coal. Recomimendations for remedying these de-
fects, which can be carried out at a moderate cost
and which will result in a considerable saving,
annually, have lately been made.
The hospital is equipped with an excellent
refrigerating system and ice manufacturing plant
of one and one-half ton capacity daily which, un-
fortunately, has not been kept up to its fullest
efficiency and is now being renovated at some
cost. The hospital does not need a large amount
of ice and other city institutions will be supplied
from the City Hospital plant, under an exchange
voucher system, with a distinct saving to the city.
The building is in daily need of repairs, some
of them frequently urgent. Requisitions for the
engineering or carpenter departments are made
on special blanks. These are 0. K.'d by the super-
intendent and endorsed by the engineer, and a
man to whom the job was assigned, in turn, signs
the requisition stating when the work was com-
pleted and what material was used. This blank
from which the repair cost is computed, is then
returned to the superintendent.
In winter, sufficient steam must be maintained
to heat the building and sterilizing plants, in
addition to supplying the hot water for the build-
ing, power for the laundry, and power to operate
the electric light plant and elevators.
III. INTERN STAFF
The proper maintenance of a full supply of
competent interns with rotation of service, during
these trying days, is most difficult and serious.
Most full-blooded Americans have a natural de-
sire to get into the fray as soon as they are
qualified, but fortunately the Surgeons-General
of the Army and Navy consider a man much
better qualified for military service after he has
had a year's internship in an acceptable hospital.
Medical students of draft age are in the Medical
Enlisted Reserve Corps, obtaining a release from
the draft in order to finish their medical studies.
On graduation the young doctor is commissioned
in the Medical Reserve Corps and placed on de-
tached duty during the period of his internship,
reporting, every three months, to the surgeon
general, by letter, to be accompanied by a state-
ment from the superintendent as to his accept-
ability and efficiency. In case of some great
emergency he is at the call of the surgeon general.
The class of 1918, in most medical schools, will
be much smaller than for a number of years, and
the number of interns available will necessarily
be inadequate for all the hospitals in the country.
This has been the case in the Louisville City
Hospital and, with the approval of the Board of
Safety, six senior students have been appointed
as student interns. They live in the hospital and
do the work of graduate interns, except the ad-
ministration of anesthetics and the signing of
death certificates. Before the end of the session
each member of the senior class who could do so
will have served a term as resident student intern.
The seniors have acted as admission officers and
ridden the ambulance, and the experience gained
has been invaluable to them.
A rotation of service is essential to the broad
education of the intern, and the assistance ren-
dered here by a competent resident physician is
invaluable to the superintendent. He is valuable
in seeing that histories ar-e written up and the
work kept up on the wards ; in answering emer-
gency calls, in the absence of the intern and visit-
ing staff; and in transferring patients and keep-
THE MODERN HOSPITAL
171
ing the house clear of chronic cases, where pos-
sible, so that their beds may be ready for acute
cases.
IV. NURSING
This includes selection of the nursing person-
nel, maintenance of the proper morale, arrange-
ment of curriculum, and distribution and rota-
tion of service.
The nursing personnel is a vital part of the
hospital and its work. Much depends upon the
type of woman who applies for admission to the
training school. The legal requirement in Ken-
tucky of a one-year high-school education is a
wise one. The judicious weeding out of the unfit
in the probation class is highly essential.
There are too many training schools for nurses
in hospitals which are, because of their size, in-
adequately equipped and not prepared to give a
complete course of training. An affiliation must
be made with a larger hospital to supply the
deficiencies in the curriculum. General hospitals
with charity patients only can well affiliate with
hospitals caring for pay patients, in order to give
their pupil nurses a broader viewpoint.
The Waverly Hills Tuberculosis Hospital affili-
ates with the City Hospital, giving their nurses
one year's training in surgery, obstetrics, pedi-
atrics, and contagious diseases. Because of the
inadequate training at Waverly Hills and the
difficulty of obtaining sufficient probationers in
this training school, an arrangement has been
perfected for the City Hospital Training School
to take over the Waverly Hills Training School,
sending fourteen City Hospital nurses to Wav-
erly Hills for a period of four months for train-
ing in tuberculosis nursing. This will do away
with the duplication of the lecture courses in
each institution, insure the same standard of
entrance requirement, and remove the spirit of
■caste when two separate institutions are repre-
sented in the training school of one hospital.
The plan adopted by the Cincinnati General
Hospital has much in its favor. Their training
school for nurses has been taken over by the
University of Cincinnati, which offers the nurs-
ing course as one of its science courses, one or
two years of academic work and three years nurs-
ing leading to the science degree. The close
affiliation of the Medical Department of the Uni-
versity of Louisville with the hospital enables the
curriculum of the training school to be taken care
of, for the most part, by the medical faculty.
V. LABORATORY
Highly specialized and equipped laboratories
and pathological department are most important.
The laboratories of a hospital are essential to
its proper conduct. Here must be made examina-
tions in serology, bacteriology, clinical micro-
scopy, and surgical and morbid pathology. In-
timate association between the school and hos-
pital in this department with an all-time chief, is
the only satisfactory method of carrying out the
details of thi.> work.
The hospital is equipped with ward labora-
tories where the laboratory nurse, changed each
six weeks, makes all routine admission urinalyses,
supplemented by examinations by the intern, if
the urine is pathologic. The students, in their
capacity of ward clerks, do the subsequent urin-
alyses and blood counts in those cases assigned to
them. The autopsy sei'vice at the City Hospital
is not surpassed anywhere. It is largely what the
interns make of it, as many autopsy permissions
can be obtained if properly presented to relatives
or friends. The members of the senior class,
whose teaching activities are confined entirely to
the hospital now, are required to witness ten
autopsies and present a protocol of each as a part
of their undergraduate record. Much could be
written of the value of a well-equipped labora-
tory to the clinician, but this is superfluous here.
The excellent record made in cases of epidemic
cerebrospinal meningitis this winter, following
prompt laboratory diagnosis, is but one evidence
of the practical application of these facilities.
VI. LAUNDRY
The economical and efficient opei'ation of the
laundry department, with prompt deliveiy of the
finished products, is a problem to be met. We
found white goods being washed with blue ging-
hams with resultant staining of the white goods
beyond possibility of bleaching. It was formerly
the custom for the orderlies on each ward to call
for and deliver, to their own and the female
wards, the clothing and bedding w'hich was
marked and kept separate for each ward. This
method of delivery kept the orderlies ofl" their
wards for long periods at a time, and a messenger
boy has since been employed for the delivery of
supplies from storerooms, drug rooms, and
laundry. The method of separating clothes has
been discontinued also, all wards requisitioning
on the laundry for supplies. The operating room
and the isolation and baby wards are kept sep-
arate from the general ward supplies.
VII. KITCHEN
The economical and tasteful preparation and
service of food, to patients and to staff, are two
distinct problems.
There has never been a regularly employed
dietitian at the City Hospital. This department
is one of the most necessary to the success of an
172
THE MODERN HOSPITAL
institution. Food values must be computed, bills
of fare for patients, help, nurses, and doctors,
must be carefully thought out and the prepara-
tion of food in the kitchen must be supervised.
Most important is food conservation and waste.
We found that formerly all garbage was inciner-
ated on the wards ; hence there was no idea of the
food waste. Proper garbage containers were
ordered and all food waste was collected from
the wards. Much to our surprise, the first week
showed a waste of 3,531 pounds, which was sold
on contract for fattening hogs. Steps were taken
at once, looking toward the cutting down of this
waste. We had heard of the excellent system in
use at the Base Hospital convalescent dining room
at Camp Zachary Taylor,^ and a visit was made
there at the dinner hour. Captain Deenen, M.
R. C, in charge of this dining room, addressed
the men before they sat down and pointed out
that every man was expected to eat all he wanted,
but he was not to take any more food on his plate
than he could eat. Not more than half a pint of
waste was left on the plates of 275 men when the
meal was finished. The commanding general
was asked to detail Captain Deenen to the City
Hospital to have him make the same talks to the
patients and help in the hospital, which was done.
The results have been most gratifying. The
average weekly amount of garbage has been re-
duced to 2,340 pounds. The cooperation of nurses
and maids with the department of dietetics is
responsible for our success in meeting this prob-
lem of waste.
VIII. BAKERY.
By installing this department a better quality
of bread is made, and pastries and other delica-
cies can be served, which is not possible if this
department is not opei'ated.
A bakery, with an old-style but efficient oven,
was included in the general plan of the hospital,
but was never used. Investigation showed that,
while it might not prove economical to operate
the bakery for making the bread consumed in the
hospital alone, supplying the bread used at the
other city institutions would make it profitable.
Pending the arrival of the Ford truck ordered to
deliver bread and ice to the other institutions, a
cost account has been kept of the bakery, which
shows the following:
Three hundred and nine pounds of bread made
at the hospital at a cost of $17.52 (the cost of
7 cents a pound paid for bread under contract
would have been $24.64) resulted in a saving of
$7.12 a day, and the hospital has had a much
better grade of bread.
2 Describd in The Modern Hospital, Ju1> 191S, p. 51.
The employment of a baker enables the hos-
pital to have pastries and other delicacies, which
otherwise would be impossible. The bread made
in our own bakery is more nutritious than the
former supply. We make a pound-and-a-half
loaf— six loaves to the pan. This minimizes the
amount of crust and this size loaf cuts more
economically.
IX. HOUSEKEEPING
The upkeep and constant cleaning of the hos-
pital is one of the most vital to the successful
operation of the plant. The housekeeper must see
to the maids and janitors, and to the washing and
cleaning of windows, wards, and halls. The fact
that there are 5,477 window panes in the hospital
emphasizes the difiiculty of this detail. She must
also keep up the supplies for all departments,
save the engineering and drug-store. Only eter-
nal vigilance can produce cleanliness in this cli-
mate. The scarcity of labor has been a very
serious handicap in this department also.
X. OUT-PATIENT DEPARTMENT
The maintenance of a free dispensary easy of
access to the sick poor is essential.
The out-patient department of a large general
hospital is a necessary adjunct to it. The City
Hospital cares for a walking clinic of from 200
to 225 patients daily. It is true there are many
cases which impose on the generosity of the city
in being cared for when well able, financially, to
pay for their medical advice, but our social service
department will shortly be able to do much toward
solving the problem of eliminating these im-
postors. Much could be said of the excellent
work being done by this department of the hos-
pital which has been lately established. Social
diagnoses are made of all bed cases, and homes
are investigated before patients are discharged,
thus obviating neglect and the possibility of the
patients being readmitted to the hospital. The
enlarged venereal clinic," which is being con-
ducted with the collaboration and active assist-
ance of the U. S. Public Health Service, is worthy
of special mention, as it is bringing expert advice
and treatment to the infected people of the com-
munity who otherwise would generally receive no
medical attention.
An average of eighty injections with arseno-
benzol are given each week, the drug being
furnished by the Public Health Service. The hos-
pital maintains a supply which it dispenses at
cost to those who can aft'ord to pay for the medi-
cine but who cannot pay for its administration.
The Public Health Service pays the salary of
, Described by Dr. Stuart Gr
, The Modern Hospital. May, 1918,
THE MODERN HOSPITAL
173
two all-time assistants in the out-patient venereal
clinic, one of whom also acts as admission oflicer
for the hospital. They also pay the chief of the
laboratory service and an assistant for the neces-
sary serological work done for the venereal
clinic. Salvarsan is administered Tuesdays and
Fridays in the out-patient department.
The drug store of the hospital is a depository
for the State Board of Health biological products
produced by Squibb, and a complete stock is kept
on consignment, being paid for as used. The
antirabic vaccine will shortly be installed through
special arrangements. Those who can pay, can
obtain it at cost. An average of 180 prescrip-
tions are filled here each day, in addition to which
prescriptions for the District Nurses' Associa-
tion and the Tuberculosis Hospital are filled.
X. VISITING STAFF
It is needless to state that a hard-working, Cbn-
scientious, and deeply interested visiting staff is
essential to a successful hospital. There must be
hearty cooperation in all departments, and the
freest consultations between department heads.
There may have been many changes in the staff
owing to the demands of the Army Medical Corps,
but the gaps have been filled in and the sick are
getting every attention.
There may have been many changes in the staff
worked out, but these will be taken up in due
course.
We have found much help in weekly or bi-
monthly round tables, at which the heads of all
departments are present. Here the problems of
one department which may involve another are
discussed and a mutual helpfulness engendered.
Instead of cross-purposes and criticisms, there
is more of a spirit of pull together which is for
the betterment of the entire service.
The following, which we hope will add to the
efficiency and usefulness of the hospital, may be
mentioned as having been introduced ; a social
service department ; a dietitian ; the operation of
the bakery; two all-time men in the out-patient
department to look after the venereal clinic and
between hour patients ; serving patients' meals
one hour later than formerly ; student interns to
fill in the intern service ; a new ambulance ; serv-
ing bread and ice to other city institutions ; and
a start at the painting of the entire interior of the
building.
HOSPITAL ACCOUNTING
Books That the Superintendent Should Keep — Journal, Charge Register, Pay Roll, Pay
Patients' Ledger, Cash Income — Method of Keeping These Books
By CHARLES A. PORTER and HERBERT K. CARTER, of the Staff of the Modern Hospital
[Continued from August issue, p. 107]
BOOKS AND ACCOUNTS OF THE SUPERINTENDENT
The Superintendent of the larger institutions
keeps all of the books that deal with the operation
of the hospital, and makes a report to the Treas-
urer, who keeps the corporation books and con-
trolling accounts.
The books that the Superintendent should keep
are:
1. Journal.
2. Charge Register.
3. Pay Roll.
4. Pay Patients' Ledger.
5. Cash Income.
JOURNAL ENTRIES
It is necessary for the ordinary hospital to keep but six different classes of entries in this book,
examples of which are given below :
6. Cash Expenditures.
7. Expense Analysis.
8. General Ledger.
9. Trial Balance.
The Journal is one of the original books of en-
try, and takes care of all items that cannot be
entered directly into the Cash Book or Charge
Register, such as uncollectable accounts receivable
charged off during the month, overpayments by
patients transferred to miscellaneous hospital
earnings, losses and depreciation of supplies, etc.
Superintendent's account with Treasurer
Accounts receivable • ■
For uncollectible accounts receivable charged oflf during the month.
.Dr.
.Cr.
174 THE MODERN HOSPITAL
2
Overpayments by patients Dr. $
Accounts receivable ^^- *
For overpayments by patients for services unrendered and not liable to be refunded
to patients, and therefore transferred to miscellaneous hospital earnings by authority of.
3
Supplies, inventory !-*■"■ *
Superintendent's account with Treasurer Cr. $
Inventory at end of period to offset amount charged off for supplies during period.
This entry will not have to be made where a monthly charge to departments for supplies
is kept, except to balance account at end of fiscal year.
4
Superintendent's account with Treasurer Dr. $
Supplies Cr. $
Charge for depreciation and other losses.
5
Superintendent's account with Treasurer Dr. $
Unclaimed wages Cr. $
For unclaimed wages transferred to miscellaneous hospital earnings.
6
Discounts Dr. $
Superintendent's account with Treasurer Cr. $
For the transfer of discounts to the Superintendent's account with the Treasurer in
case a profit and loss account is not kept in the Ledger.
When the Journal entries 1 and 3 are made, to which entries may be posted and referenced,
notations should be made on the Pay Patients' Accounts which it will be necessary to open are:
Ledger Cards, showing the date of such transfer. Pay Patients' Bills Receivable, Advance Payments
Where it is necessary for the Superintendent by Patients, Overpayments by Patients, Bills Pay-
of a hospital to open a set of books by the double able. Equipment, and Superintendent's Account
entry system, entries must be made in the Jour- with Treasurer. He may open these accounts as
nal in order to open the necessary Ledger accounts shown by the following examples :
1
Superintendent's cash account Dr. $
Superintendent's account with Treasurer Cr. $
For cash on hand the last day of the month, not including overpayments or advance
payments by patients.
2
Superintendent's cash account Dr. S
Advance payments by patients Cr. $
Account advance Payments on hand the last day of the month.
3
Superintendent's cash account Dr. 3
Overpayments by patients Cr. $
Account overpayments by patients.
4
Bills receivable Charge Register Dr. $
Superintendent's account with Treasurer Cr. $
5
Supplies account Charge Register Dr. $
Superintendent's account with Treasurer Cr. $
6
Superintendent's account with Treasurer Dr. $
Bills payable account Cr. $
SUPERINTENDENT S CASH ACCOUNTS
mended. These are : General Cash Book, Pay
Patients' Cash and Receipt Book, and Combina-
The use of three books by the Superintendent tion Cash and Check Book,
for the handling of all cash transactions is recom- The daily totals of the Dispensaiy and Pay
THE MODERN HOSPITAL
175
Patients' books, payments to the Superintendent
by the Treasurer, and sales and miscellaneous i-e-
ceipts are entered in the General Cash Book and
a bank deposit slip made out to correspond there-
with.
The Pay Patients' Cash and Receipt Book
(Form 20) gives an itemized statement of pay-
ments by patients. In cases where someone other
than the patient makes payment, this fact is re-
corded. The individual Pay Patients' Ledger
Cards (Form 21) are posted direct from this
book. The same form of receipt may also be
used in the dispensary and emergency wards. The
use of this form saves the posting of such items
to the Cash Book, and consequently saves time
and reduces the chances of error.
The Combination Cash and Check Book (Form
18) and its companion book, the Charge Register
(Form 13), give a complete record of all cash
expenditures, including copies of the checks and
distribution of the expenditures.
The General Cash Book (Form 17) is arranged
to show the totals of the principal daily receipts
and expenditures and detailed entries of cash
transfers between the Superintendent and the
Treasurer, and other miscellaneous items. (Forms
17, 18, 19, 20, and 21 are shown in later instal-
ments. )
On the debit side of this Cash Book columns are
headed hospital earnings and miscellaneous. Hos-
pital earnings are subdivided into ward patients,
private room patients, dispensary, emergency
ward, and other receipts. More columns may be
used if desired, but these will be enough to enable
the average institution to make an easy recapitu-
lation at the end of the month.
In hospitals where the volume of business is so
great as to make further reductions necessary,
headings for each of the other main sources of
hospital earnings may also be used, such as x-ray
service, special nurses, laboratory fees, telephone,
and sundries.
The credit side of the Cash Book has columns
for dates, payees, discounts, refunds to patients,
bills payable, and miscellaneous. Cash discounts
should be entered in this book, although, strictly
speaking, they are not cash items, but are reduc-
tions of payments.
Transfers of cash between the Superintendent
and the Treasurer are entered in the miscella-
neous columns, debit or credit, as the case may be,
and posted direct to the Superintendent's account
with the Treasurer.
At the end of each month a recapitulation of all
cash receipts should be made on the debit side of
the Cash Book in the following form :
January 1. Cash on hand.
Hospital earnings:
Private room patients .
Ward pay patients. . . .
Dispensary
Emergency ward
Ambulance fees
Special Nurses
Guests' fees
Operating room fees. . .
X-ray fees
Laboratory fees
Hydrotherapeutic fees.
Sales of refuse
Miscellaneous
Total hospital earnings.
Received from Treasurer.
Etc
Etc
Etc
Total receipts
A recapitulation of cash expenditures should be made on the credit side of the Cash Book in the
following manner :
January 1.
Accounts payable
Refunds to patients
Cash remitted to Treasurer.
Total payments
176
THE MODERN HOSPITAL
f Cash on Hand:
Advance payments by patients .
Overpayments by patients
General cash
Total.
The totals of the two recapitulations should
agree.
In hospitals where the receipts are remitted to
the Treasurer it is not customary to remit ad-
vance payments by patients and overpayments by
patients, as they represent funds which have not
been earned by the hospital and are simply held
in trust by it. These two items are shown in the
Cash Balance in the Cash Book in order to make
it unnecessary to keep a cash account in the
Superintendent's Ledger.
POSTING
All cash items should be totaled and posted to
their respective Ledger accounts as follows :
Cash received during the month on account of
hospital earnings should be credited direct to ac-
counts receivable.
Cash received from the Treasurer should be
posted direct to the credit side of the Superin-
tendent's account with the Treasurer.
Cash disbursements on account of accounts pay-
able should be posted direct to the accounts pay-
able account.
Cash remitted to the Treasurer should be posted
direct to the Superintendent's account with the
Treasurer.
Discounts as shown by the discount column are
posted direct to accounts payable and transferred
to the discount account through the Journal.
These do not appear in the recapitulations on the
Cash Book pages because they are not cash items.
but are savings made by the timely payments of
bills rendered to the hospital.
Cash refunded to patients during the month on
account of overpayments are debited direct to
overpayments by patients' account.
Reference should be made in the folio column
of the Cash Book to the pages in the General
Ledger to which the various postings are made.
superintendent's petty cash funds
It is necessary for the Superintendent of a hos-
pital to have a petty cash fund from which to pay
small current items, such as messengers, postage,
time checks, express, and miscellaneous items.
By studying past conditions, the accountant can
estimate the amount of money needed in this petty
cash fund. At the end of each month, and at
times during the month if necessary, checks are
made out to bring this fund up to the amount
called for on the general books. The proper
handling of this fund is one of the most impor-
tant parts of a complete accounting system.
When making petty cash payments, Form 11
should be used and the signature of the payee
secured. This petty cash voucher should show the
item for which the money is spent and the account
Petty CnsH Voucher no. y-9
Rcctii^ct from OolJani
from THE MODEfln HOSPITAL
Poi/meitt in full of folloi^inf
Dafc 3tgne.d
For
OePflRTMEMT
flmcun-C
Form 11. Petty Cash Voucher. Actual size, 5 by 3 inches.
to which it is to be charged. These vouchers are
placed in an envelope (Form 12) at the end of
the month, which shows
the voucher numbers, the
date. Invoice Jacket cov-
ering these and the dis-
tribution of the expendi-
tures. The distribution
to departments or ac-
counts is shown, and the
total on the envelope
plush the cash remaining
on hand must equal the
amount of the fund. A
check is drawn to cover
the expenditures as
shown by the Invoice
Jacket, and these trans-
actions are complete.
CHARGE register
The foundation of cost accounting for hospitals
is the Charge Register (Form 13). It replaces
the Bills Payable Ledger, and gives a complete rec-
oi"d of all transactions for which money has been
or is to be expended by the Superintendent for
bills payable. As soon as bills are received, In-
voice Jackets should be made out and entries made
in this book.
Column headings, arranged to correspond with
the classification of expenses as determined on
V / Voucher
^-^_^ No..-.. ..
Petty CasH Vouchers
rios TO InCLUiive
Date /?/---
D'iTRieuTwn
fluouriT 1
CoiPonATiot^
Po.!T«»(
OtP«BT«Er>Tj"
Total
,-.rr«r,05 TO P„„,.r.
roT«L
Form. 12. Petty Cash Vouche
Envelope. Actual size, 3M
by BVz inches.
THE MODERN HOSPITAL
177
when making up the distribution of expense, are
printed in the Charge Register. Where there may
be but two or three bills per month for a particu-
lar subdivision of expense, a column is not
reserved, but these are entered under this miscel-
laneous heading of the general classification to
which they pertain and the account noted in a
column for the purpose.
As explained in the introduction to this text, it
is impossible to show a form of Charge Register
that will exactly suit the needs of every hospital,
debited or credited. The purpose of having the
debit and credit columns under sundries is so that
insurance supplies and other prepaid accounts can
be put through the Charge Register from month
to month and not fully charged off during the
month in which they occur.
At th£ end of each month the columns of the
Charge Register are footed, and it is a simple mat-
ter to make the necessary recapitulations in order
to show the totals of each division of expense en-
tered upon the Expense Analysis (Form 22,
Form 13. Charge Register: above, the left-hand page: below. riKht-hand page. 19^2 by 15
added at left of higrht-hand page and right of left-hand pase.
nd book, with binding margin to be
but the one which is shown (Form 13) will meet
the needs of the average institution. Anyone
understanding the principles of cost accounting
should experience no difficulty in making such
additions to or deductions from the form shown
as to meet the requirements of any institution.
The Charge Register sheets (shown in Form
13) are slightly different from those now in gen-
eral use among hospitals. The first column is
used for the Invoice Jacket number. These num-
bers are supposed to be entered in numerical se-
quence. The date of the invoice is entered in the
first dating column, and then the name of the ven-
der or the person to whom the item is payable.
There are two credit columns shown. The first
■ is for those items for which money is spent that
are not a general expense, but are additions to
capital accounts or a deduction from earnings.
The second is for expense items. A second dating
column is given in which the date when the bill
is paid should be entered. This shows at a glance
ju.st what bills remain unpaid. The distribution
column is for an explanation of the account to
which the item is chargeable, and will not have
to be used for eveiy entry. The general expense
columns are self-explanatoiy.
The last columns of the second sheet are : mate-
rial, in which all items that are purchased for sale
or to be used for buildings and charged later to
the capital accounts are recorded; explanations,
for necessaiT descriptions of the various ac-
counts ; and an account column, for the entry of
General Ledger accounts to which sundries are
shown in a later instalment) or to their proper
General Ledger account. A folio column is given,
so that these may be properly referenced.
[To be continued.]
Moving Pictures Displayed on Camp Hospital Ceilings
The problem of how to amuse the wounded soldiers who
are unable to sit up has been solved in a simple manner
by the Y. M. C, A. at the base hospitals in the camps.
Portable motion-picture machines are so stationed that
the projections appear on the ceiling, and all the patient
lying on his back need do is to look up.
In connection with the recreational and entertainment
work for the wounded and convalescent soldiers in the
cantonments the Y. M. C. A. War Work Council has just
given to the Lythic Construction Co,, of New York City,
the contract for the erection of a large hut at Camp
Upton. It will be 80 by 53 feet, with a high gable roof
and a large chimney at one end, giving it the appearance
of an immense farm house of the typically New England
home-like sort — the kind suggestive of home comforts
and of "the pies mother used to make." The building
will be ready for use within six weeks.
One of the features of a novel nature will be the so-
called "quiet room," where anyone who desires to be alone
can go. Another noteworthy matter is that there will be
a grand veranda running the entire length of the building
and overlooking the athletic grounds.
Two lady visitors were walking down the regimental
street. One said: "I like everything about this camp.
The tents and buildings and streets are all kept so clean."
The other said (as they passed an incinerator), "Yes,
but I don't think they make their coffee in a very sanitary
way." — Trench and Camp.
178
THE MODERN HOSPITAL
LIFE-SAVING SURGICAL DRESSING SQUADS IN FRANCE
St. Didier and Its Output of Surgical Dressings— Human Interest in Surgical Supplies-
Manufacture of Dressings Saving Lives of Workers as Well as Wounded
H. CRAWFORD, of the American Red Cross
By charlotte
HE HAD been hanging for nineteen months
sUing in a kind of hammock. There were
various pulleys and appliances, but the main thing
which kept him alive all that time was an in-
genious dressing which could be adjusted to his
back without disturbing him. That means some-
thing to a man whose spinal cord feels like one
long toothache. For nineteen months, this merci-
ful arrangement had made it possible to dress his
terrible wound, and at last he was beginning to
get better. The day came when the pulleys were
shifted to bring him to a sitting posture. For
the first time, he looked about the big hospital
room. Over the door was festooned the tricolor.
He raised his hand to salute, and cried out: "Vive
la France!" That was the spirit which an up-to-
date surgical dressing had saved to France and
the world.
Somehow, you think there is rather less of
human interest about a surgical dressing than
about a muffler, say, or a warm shirt or good
woolen socks. These things take on something
personal, something that reminds the wearer how
close he is to the heart of the folks at home. A
surgical dressing is put on one day and burnt
up the next. While it is being put on, the soldier
is too busy with his pain to think of the hands
which folded it or the devotion which toils day
in and day out to turn it out in quantity.
Rather less of human interest about them, isn't
there? And deadly work to make them, shouldn't
you think? Wait till you have had a look at St.
Didier I
To St. Didier one used to go to rent a tennis-
court. (The French seem to fancy the tennis-
court as historic background.) Now it lends its
ill
Fig. 1. A Red Cross surgical dressing workroom on this side.
THE MODERN HOSPITAL
179
Kig. 2. An American-made surgical
ample spaces to the American Red Cross for the
storage of great cases of gauze and surgical sup-
plies, and its wide light rooms make admirable
workrooms.
Since a mere trifle of several million dressings
are sent over from the United States every month,
St. Didier is confining itself to the manufacture
of what is known as "fi'ont parcels." These are
in three sizes, for large wounds, small wounds,
and middle-sized wounds. They go to the ad-
vanced emergency stations and contain each a
complete dressing for one wound. They are
wrapped in sterile bags before being put in paper
and paraffined. By pulling on a string, the sur-
geon has the whole contents open ready to his
hand. Some of the women at work in St. Didier
turn out one hundred and thirty of these in a day,
the average number per worker being seventy.
As there are three hundred and fifty paid workers
at St. Didier, not counting volunteers, you may
form some estimate of the daily output of dress-
ings turned out in this great workshop.
Looking over these busy rooms, the bandage-
machine rolling the material in great rolls, the
cutting-machine measuring off the rolls into dif-
ferent sized bandages, and the nimble human
machines, folding, preparing, and packing the
output, you feel inclined to liken it to a great life-
saving station; for before your mind's eye there
rises up the vision of another room — an ambul-
ance dressing-room near the front.
Along the walls are tables, spread with sterile
towels and neatly piled with all kinds of dressings.
The orderlies bring in a badly wounded man on a
stretcher and lift him to the operating table. Off
comes the old dressing, blood-stained and foul
with pus. It is tossed into a pail to be burnt up.
ires=ing being applied "over there "
The surgeon reaches out a pair of interrogative
forceps, and the nurse deftly jabs hers into a pile
of dressings, and hooks the very thing he needs,
and there is no break in the chain until the blesse
is lifted back on the stretcher, with his wound
cleaned, dressed and protected from infection by a
fresh dressing. And sometimes, when it is a busy
day, with no time for cleaning up between blesses,
the floor gets slippery under the feet of surgeons
and nurses, and the cast-off tampons and bits of
gauze lie about, red with the costly dew that is
keeping the trees of Liberty alive for all the
world. So even these little cast-off, disregarded
scraps of gauze have a part in the gi'eat fight
against despotism, and blush with a decoration
before they are swept away!
Not much human interest about surgical dress-
ings, did you say?
The Red Cross is now employing about five hun-
dred women workers at its three big workshops in
Paris. Incidentally, they are doing a life-saving
work right there. Most of these women are refu-
gees, only too glad to work for something less
than a dollar a day. At the present moment, that
is hardly a living wage in Paris, and the Red
Cross is about to open a canteen where these
women workers can get at least one good free
meal each day.
But, you say, with several million dressings a
month from the United States, and three work-
shops going full blast in Paris, will the Red Cross
not be overstocked with surgical supplies? Up
to the present, there have never been too many.
What the future holds, we cannot say. But one
thing, we are resolved, it shall not hold — the loss
of precious life through lack of life-saving de-
vices in the shape of up-to-date surgical dres'^ings.
180
THE MODERN HOSPITAL
A NEW EXPERIMENT IN TEAM-WORK FOR THE PUBLIC HEALTH
The Cincinnati Public Health Council — An Interesting and Successful Plan for Coordinat-
ing Community Effort — Form of Organization and Methods of Work
By COURTENAY DINWIDDIE, Executive National Social Unit Organization, Cincinnati
THERE is nothing on which it is easier to secure
a general and enthusiastic agreement than the
need of common planning and team-work for the
public health. It is easier to agree upon general-
izations. But, sometimes, when we come to par-
ticulars, we find that the other man's idea of
cooperation is to let us do the work, or to have
us do just what he wants; or perhaps he has
similar opinions about our own ideas. It is when
we translate our attractive phrases and our gen-
eral ideas into concrete forms of organization or
methods of planning and working together that
we can really tell what we mean and how nearly
we are in agreement.
These are times in which it is of vital import-
ance for us to conduct a searching inquiry into
the real value of our methods of cooperation, of
elimination of friction and waste effort, and of
conservation of energy. This is particularly
applicable in the public health field, as every new
fact disclosed by a study of conditions in the
warring countries reemphasizes the urgent neces-
sity of taking time by the forelock in planning
and carrying out preventive health work as a
war measure. England's splendid success in re-
ducing infant mortality in the face of war-time
conditions is a positive illustration of the import-
ance of preventive measures. Where public
health measures have not been forehanded but
rather have been adopted after health problems
have become acute, the increases in tuberculosis
and other diseases paint an appropriately somber
negative background.
There have been more examples of efforts to
bring about coordination and team-work in the
Fig. 1. This sleeping porch was screened and fitted up l>y the Anti-Tuberculosis League,
the organization which was the forerunner of the Cincinnati Public Health Council.
In addition to its efforts for city-wide improvement of housing and living condi-
tions, the league is continually helping in the individual homes. It maintains a
nurse and a visiting housekeeper, and in every way endeavors to help families to
raise the sanitary and economic standards so as to eliminate disease-producing
conditions.
Fig. 2. This West End tenement, with a recm-i
culosis in one year, is a type of the coml
has set out to abolish.
general field of social service than there have
been in purely health activities. In the main,
the general principles underlying
forms of organization or methods of
work in the two fields are much the
same, and successes or failures in the
one may be taken as typical of the
other. We have a number of ex-
amples of such efforts in public health
leagues, community welfare associa-
tions, councils of social agencies, and
other similar organizations.
Usually, in the formative period of
such organizations, there is a laud-
able effort to secure democratic rep-
resentation from the various agen-
cies, and an opportunity for the dif-
ferent interests which are co-
ordinated to continue to express their
views and carry out their purposes.
Unfortunately, however, there often
arise examples of working at cross-
purposes and instances of constituent
agencies feeling that there is an at-
tempt to dominate or eliminate them
THE MODERN HOSPITAL
181
without open and friendly discussion of points at
issue.
Probably the chief cause of such conditions has
been the lack of a definite plan of organization
from the bottom up in social service. Usually
the central organization, whether existing before
the federation or formed for the purpose of
federation, comes to be considered as a separate
organization apart from its constituents. The
board of directors, however its election is pro-
vided for, is apt to be a self-perpetuating body in
which some of the other agencies do not have a
l-ie, ;■;. 1 no F.amior.i Huis Lamp, maintained by the Cincinnati Anti-
Tubercuiosis League for anemic children, has been one of the
league's most successful activities. One of the mothers "never seen
anybody that was as skinny and poor as these girls were get so far
in so short a time in my life."
real voice in planning policies and methods of
work. This might be taken as a condemnation of
federation in social service or public health work,
but it is by no means so intended. Federation and
coordination are timely and necessary, and with-
out them we shall not improve our present meth-
ods of work to any very considerable extent.
I believe that the real
causes of the difficulties
that are met in efforts for
better organization are to
be found in the lack of pro-
vision for common plan-
ning, frequent and intimate
discussions of policies, and
definite cooperation in act-
ual service. The form of
organization and methods
of work of the Cincinnati
Public Health Council are
an expression of the
thought of some of those in
Cincinnati who have de-
sired to bring about a
better form of team-work
for the public health. In
brief, its organization is ^'"'\'..,Vs^enTrL?]^er^t t
on the following plan: ^i:"chni''^er day wll 35^5',
There are eleven divisional councils, on tuber-
culosis, hospitals, mental hygiene, social hygiene,
housing, recreation, medical relief, waste, nursing,
industrial health, and child hygiene. Member-
ship in each divisional council is open to any public
or private agency or institution, or civic, busi-
ness or labor body, which has a legitimate interest
in the field of the council's work. Each member
agency is entitled to one representative on each
divisional council.
These divisional councils are the initiators of
programs, plans, and methods of work in their
own particular fields. All the councils have met
several times and agreed upon programs for the
solution of their particular problems.
The spirit in these meetings has been excellent.
It has developed that agencies working side by
side have not known many things about one an-
other's work and have not fully understood each
other's objects and methods. These divisional
councils have furnished excellent forums for full,
frank, and friendly discussion of these problems
as a basis for mutual understanding. As a result,
the programs drawn up have represented, not a
superficial, but a real unanimity of opinion. In
a particular field one or two agencies may stand
out as the leaders because of their position and
objects. But, instead of "going it alone" or hav-
ing a casual cooperation, these agencies secure
advice and suggestions from all the others in
the same divisional council. As a result, the
others not only give heartier and more under-
standing support, but can aid in carrying out
many parts of the program through helpful ad-
.I'ustments in their own fields and direct service.
the camp are healthy children ..:- . :.....;,, ■_, l.l: Jl--. The children
the gardening, and the fresh vegetables pruJuceJ in the camp garden
:pense of food materially. In 1915, for instance, the maintenance cost
enls, and the average cost of food per meal was 6.96 cents.
182
THE MODERN HOSPITAL
Fig. 5. The picnic lunch
child makes up his o\
light tasks about the
spent in wholesome re
is a special camp privilege. Although each
'n bed and takes turns in performing other
Icrmitory and kitchen, most of the days are
:reation.
In fact, it was the demonstration of these prin-
ciples in the Municipal Tuberculosis Committee,
organized by the Anti-Tuberculosis League,'
which led to the organization of the Public Health
Council. Meetings from time to time have given
opportunities for revision of plans and policies
and for working out methods of carrying into
effect programs adopted.
The coordinating force among these divisional
councils is the public health council as a whole,
^mm
^ ,
■: '-'V -■■
■ipt'^ :'!^''
^hL
0
ir
^^^1
'4
?6?,T..t?A*,\T
■. 6. A city-wide canipni- n ;i,;in, t the pernicious practice of spit-
ting in public places was inaut'u rated in April. 1916. A corps of
700 workers, including 400 Boy Scouts, on April 17. painted on the
main street corners and at frequent intervals on many sidewalks
the sign, "Don't Spit on Sidewalks." Through the cooperation of
the police this campaign was carried out quietly and thoroughly,
and proved most effective in attracting attention. It was followed
by a newspaper campaign and arrest of spitters.
account of the work of the Cincinnati Anti-Tuberculosis
cinnati's Successful Antituberculosis Campaign," by
to which every member agency is entitled to send
two delegates, an executive of the agency and
another representative, usually a member of the
board of directors, except in the case of public
departments and institutions. The reports and
programs of the divisional councils come in to
the public health council for coordination and ap-
proval. The chairmen of the divisional councils,
together with the officers of the public health
council, constitute a coordinating committee,
which considers proposed programs and amend-
ments and then submits its recommendations to
the public health council as a whole. In case
of need for immediate action the coordinating
committee is authorized to act in the interim be-
tween meetings of the entire council. The dis-
cussion of the recommendations of the divisional
councils by this coordinating committee has
proven another valuable means of securing better
understanding and closer cooperation.
A still further step of great importance has
been taken in Cincinnati in an agreement be-
tween the public health council and the council
of social agencies, by which the former has be-
come the autonomous public health division of
the latter. This is a long step forward toward
real organization of community effort. It is also
a tribute to the democracy of the Cincinnati
Council of Social Agencies and to the cooperative
spirit of both organizations.
Having laid this new foundation under public
health work of the city, our next move should
be to see to it that the foundation rests solidly
upon the people of the city as a whole: Only
with such support will public health work reach
its ultimate goal.
The work of the council is now going forward
encouragingly under a full-time executive, Mr.
Arthur H. Burnet, for five years the director of
the social service division of the health depart-
ment of Toronto.
Work thou for pleasure; paint, or sing, or carve
The thing thou lovest, though the body starve.
Who works for glory, misses oft the goal.
Who works for money, coins his very soul;
Work thou for work's sake, and it well may be
That these things shall be added unto thee.
— Kenyon Cox.
Let us see to it that nothing good in us goes unex-
pressed ; for every right impulse given effect we gain a
thousandfold. — Stephen Berrien Stanton, "The Hidden
Happiness."
1 For an
League, see
Courtenay Di
■iddie (The Modern Hospital. December, 1916, p. 400),
When one door closes another always opens, but we
usually look so long, so intently and so sorrowfully upon
the closed door that we do not see the one that has
opened. — Jean Paul Richter.
THE MODERN HOSPITAL
LITTLE JOURNEYS TO PLACES AND PEOPLE WORTH KNOWING
183
The Fourth Little Journey To Grant Hospital, Columbus, Ohio— A Private Hospital, Free
from Commercialism, Giving Care to People of Moderate Means
By MAUCARET J. ROBINSON, R. N.. Field Kditor of T}ik Modern Hosi'Ital. Chicago
I SAT waiting for a while in a little reception
room at the riyht of the entrance hall in Grant
Hospital, and had plenty of time to count the
stars in the service flag, seventy of them, and the
sign on the wall reading, "Turkish Bath, Barber
Shop and Cigar Stand in the Basement." This
looked good. What a time-saver it must be not
to have to send a nurse or orderly or someone else
around the corner everv time that Tom, Dick or
There are 250 beds in the hospital buildings.
The training school has 115 student nurses en-
rolled and to meet the national need, is enrolling
more as fast as accommodations can be provided
for them. The hospital employs a force of
competent office clerks, bookkeepers, interns,
laboratory assistants, dietitians, supervisors, and
domestic attendants.
Ten percent of all patients cared for in the hos-
Ficr. 1. The walks and trees o£ Grant Hospital hlenii with the Libral-y Park opposite.
Harry wants a package of cigarettes or of choco-
late or the evening paper — and what a blessing
it must be to have a barber handy when you want
him for a patient !
When Miss Jamieson, the superintendent, was
free to attend to stray visitors, I followed her
about for an hour or more, getting acquainted
with the physical properties of Grant Hospital
and trying to learn something of the spirit of its
work.
In so far as we know. Grant Hospital is the
largest privately owned hospital in the United
States. It was originally started by a stock com-
pany of doctors and other individuals and was
considered as an investment, but at the present
time it is owned by a company of physicians, or-
ganized by Dr. J. F. Baldwin on the "not for
profit" basis provided for by the laws of Ohio,
and is managed just as any general hospital would
be managed. The surplus funds, when there are
any, are used to pay indebtedness, or are returned
to the hospital assets to provide for the growth of
the work done.
pital receive free treatment. No deserving patient
is ever refused admission. Officers and men of
the aviation camps nearby are cared for at the
rate paid by the government, which is less than
half their cost of maintenance in these days of
inflated prices for everything we use in hospitals.
Sick children who are taken care of in the fresh-
air camp during the summer and who are too ill
to be returned to their homes are treated free in
the children's wai'd during the winter months.
Perhaps the thing of greatest importance in
Grant Hospital is that the largest part of all serv-
ice given to the sick is to people of moderate
means for moderate rates. There are many
rooms for $18 a week. Mothers and babies get
care in wards for $18 a week and in private rooms
for $3 a day. There are never more than four
beds in a ward. It is a rule of the house that
eacl: patient must have the ventilation from one
window for his own.
It is no wonder that Grant Hospital is nearly
always full to capacity. The wonder is that the in-
stitution can accomplish what it does and .still re-
184
THE MODERN HOSPITAL
main on a self-supporting basis, as it actually does.
The hospital is an open-door institution, but
open only in a restricted sense. No physician or
surgeon may use the hospital for his patients un-
One of the pleasant two-i
lites with bath.
less he has been passed upon by an efficiency
committee of the staff, which must satisfy itself
as to his ability before he is permitted to bring his
patients for treatment. When there is any doubt,
if the applicant is a surgeon, the chief surgeon of
the hospital and a committee of his associates wit-
ness the early operations personally.
There are twelve pupil nurses and two super-
vising nurses on duty in the operating wing of the
building. The records show an average of 350
cases per month. The surgical suite is equipped
with an emergency laboratory, which has a freez-
ing microtome. The radiographic laboratory and
cystoscopic room in this suite adjoin, in order that
rapid service may be given and skiagraphs made
for patients needing an urethral diagnosis.
A desk is provided in what is known as the
doctors' room, where an immediate record of
operations may be made by the doctors themselves
following their operative work. Nose-and-throat
work is done in a separate department of its own,
which has special operating rooms and private
rooms and ward and recovery rooms. This is en-
tirely away from the general surgical service and
away from patients in all other departments.
All nurses on duty in operating and obstetrical
delivery rooms are served with sandwiches and
hot or cold drinks in the middle for the forenoon
and afternoon. All operations are posted on the
operating board — ^"boarded," to use the technical
expression — directly with the operating room
supervisors.
The housekeeping department of the hospital is
decidedly interesting, but, as Miss Jamieson tells
all about it in a paper which was read at the Ohio
Hospital Association meeting,' I shall not trespass
on that field here. Her three neat little maids, all
sisters, who follow each other through the rooms
Fip. 4. The systematic and ever-ready maternity room.
after the patients leave them, show a splendid
way of working out this problem of getting rooms
into use again with the least amount of red tape
and time and labor.
Officers, supervisors, nurses, and clerical em-
ployees at Grant Hospital all eat in the cafeteria.
The service is economical and swift and the food
good. I do not report this from print or hearsay,
because I was a dinner guest myself the day I
visited the hospital. I stood in line behind the
superintendent, picked up a big tray, and helped
myself to a knife and fork and spoon and napkin
and glass of water. The girl behind the counter
dished out a good hot dinner from the steamers
all on one plate. Then I marched along behind
Miss Jamieson to the supervisors' dining room,
where we all sat down to talk hospital shop talk
in peace, without waiting for further service.
After dinner we went back to the main offices.
The hospital keeps a very complete card-filing
The Modern Hospital, July, lois, p. 15.
THE MODERN HOSPITAL
185
system and has a sutlicient force of people to keep
it constantly checked and up to date. One woman
clerk in the office is held responsible for admitting
patients and is left free of other work so that she
has time to perform this duty courteously and
intelligently.
A stenographer in each office makes four copies
of the patient's admittance history for each one
that enters. The first copy remains on the room
clerk's desk. The second copy goes to the switch-
board, where there are three eight-hour-shift
operators ; the third goes to the superintendent of
Fig. 5. All ready for Ihe hot and cold drinks for the nurses' dinner.
nurses, and the fourth is filed on the patient's
daily bedside chart.
The patient's room list is a large book with
black pages. It is made so that the slips of card-
board, on which are written the patient's name,
may be slipped in and out of grooves. On the
left of the page, hand-printed in white photo-
graphic ink, are the numbers of the rooms or ward
beds. On the right of the names are the rates for
each room or bed. The slips used are of different
colors. Red signifies that the patient is going
home, yellow that the room is reserved, green
that the room is clean and ready for a new patient.
It needs only a glance from a room clerk or switch-
board operator to give accurate information con-
cerning the rooms to be rented or of the move-
ments of patients who are going in and out of the
building.
Miss Jamieson took me over to Dr. Baldwin's
offices, which are in a residence next door to the
hospital, to see his system of case-record keeping,
which is very interesting and complete. As we
entered the reception room I noticed two framed
quotations on the walls, one placed just where the
eyes of each patient who enters the room can not
help but see it, and the other under the eyes of
each one who leaves the offices. They will express
to you, better than I can, the motives that govern
the daily life of this private hospital and the
people who own and supervise it:
"Let the surgeon be chaste, pitiful, merciful; not cov-
etous or extortionate, but rather let him take his wages
in moderation according to his worlc and the wealth of
urses do the charting.
his patient and the severity of the disease and his own
worth." —Guxj de Chaiiliac, 16th Century.
"If your fee is first with you and your work second,
then fee is your master and the lord of all fee, who is
the devil; but if your work is first with you and your fea
second, then work is your master and the Lord of all
work, who is God." —John Riiskin.
A friend writes from France: "The American hospitals
aro beyond anyone's comprehension here, so hygienic and
so comfortable. One has 20.000 beds; they have their own
railways, which bring the patients right in, and their own
post. Talence Hospital is now magnificent." — British
Journal of Nursing.
186
THE MODERN HOSPITAL
FROM OUR FIELD EDITORS' NOTEBOOKS
Some Beautiful Architectural Features of an Ohio Mental Hospital— Another Progressive
Sisterhood Hospital— A Successful Rural Community Hospital in Iowa-
Good Work Done by the Children's Hospital, Columbus
Dayton State Hospital (Mental). Dayton, Ohio
Driving through the lodge gates, which are framed on
each side by flower-covered pergolas, one gets a full front
view of the hospital and the rounded colonnade of white
pillars around the entrance porch. The porch and pillars
were made by patients of the hospital under the super-
vision of the superintendent, who designed it.
This institution has beautiful lawns and gardens and
Fig. 1. A view of Day to
farm land. The day I saw the hospital most of the
wards were empty, and groups of patients were every-
where outdoors, under the trees in charge of the nurses.
Many of the wards are open wards; that is, there are
no bars on the windows and no means of restraint are
visible. None is used except in the cases of excitement,
and that restraint consists of continuous warm baths,
electric cabinet baths, showers, and other hydrotherapeu-
tic treatment given by the nurses. The hospital is well
equipped to give such treatment wherever it is indicated.
Every mental hospital has some interesting types, and
the Dayton State Hospital has its share of patients with
strange delusions. One man, who was playing a game of
croquet with some other men patients when I was passing
through, seemed to be normal enough until the conversa-
tion turned to his absorbing delusion. He believes that
he owns and controls the whole world. He told us that he
had discharged the superintendent of the hospital at least
four or five times, but that the man wouldn't go.
Another, a pretty young woman, of a harmless type,
was sitting on the lawn making lace. She believed herself
to be the possessor of ninety million dollars, all the stores
in Dayton, and a lot of coaches made of pink satin and
blue kid, with wax statutes on the drivers' seats.
One woman about fifty years old was getting her les-
sons. She studies constantly, working out problems in
arithmetic and exercises in Spanish and French and Latin.
The flower gardens furnish fresh flowers for the wards
every day. It was thought at first that the patients would
destroy them, but this never happens. The patients them-
selves care for the flowers as long as they will last.
Some of the patients at the Dayton State Hospital have
been there as long as thii'ty-five years and among the
last admitted are three young soldiers fi-om the canton-
ments— men whose type of inentality was uncertain and
could not stand the strain of war.
Mount Carmel Hospital, Columbus, Ohio
Mount Carmel Hospital is administered by
the Sisters of the Holy Cross, whose mother
house is at Notre Dame, Ind. It has a bed
capacity of 175. All the supervising sisters
of the training school are registered nurses of
the state of Ohio, and there are eighty pupil
nurses in training.
The hospital is well built and beautifully
sanitary. The halls have very little hospital
atmosphere and no hospital odors. Growing
palms, color, and sunshine are everywhere.
In the diet kitchens the shelves are lined
with attractive trays, set with china that looks
more like home than hospital. The best pri-
vate rooms are provided with Minton and Col-
port and Limoges.
On one of the upper floors completely
equipped scientific laboratories are being con-
structed, and near the operating service is a
large case-recoi'd I'oom. The operating rooms
have balconies where visiting medical men
and relatives may witness operations without
getting into mischief. In the obstetrical wing
is what the nurses call the fathers' room —
a room where the husbands of patients
in this department may rest and wait for the stork's
arrival. The pleasant-faced, capable sister in charge of
the operating and obstetrical rooms has been in that
service for ten years. She must be as capable as the
sui'geons by this time.
A cozy sunlit parlor on the top floor is used as a nurses'
recreation room. The Modern Hospital was on the table
ifled colonnade of white pillars around the
porch of Dayton State Hospital.
THE MODERN HOSPITAL
187
among- the magazines which arc taken by the hospital for
the nui-ses' reading.
It is a pretty custom at Mount Carmcl to name the
corridors. There is a St. James' Hall and a St. John's
and another named St. Angela.
Jefferson County Hospital, Fairfield, Iowa
The Jefferson County Hospital at Fairfield, Iowa, was
opened for patients in October, 1912, and since that time
has thoroughly proved the success of the community hos-
pital built and maintained under a state law which pro-
vides that any county of the state must build and sup-
port its own hospital if the voters of that county say so.
It has also proved that a hospital of this size and equip-
ment, with the addition of such building changes as the
growth in census and the progress in hospital service de-
mands, is complete. and adequate as first unit for the needs
of a rural community of twenty thousand people.
The citizens of this county, conservative and more or
less suspicious of new things, as those living in the isola-
tion of rural communities always ai'e, are bringing the
members of their families, even unto the sixth and
seventh, to its open door with confidence that they will re-
ceive needed help in time of illness.
The cost of building and equipping this type of hos-
pital is comparatively small. This was met partly by
the tax-paying farmers and merchants and partly by pub-
lic subscription. The woman's auxiliary, lodges, societies,
and individuals furnished part of the equipment, ambu-
lance, and landscape gardening.
The total cost of land, buildings, and equipment was
$41,290.30. The average yearly expenditure of the hos-
pital in normal times is about $12,000, the cash receipts
nearly $10,000. The deficit is made up of the tax levied.
The Children's Hospital, Columbus, Ohio
In a charmingly situated residence building in Columbus,
handicapped by the lack of some most ordinary necessities
•of hospital equipment, the Children's Hospital not only is
The hospital has been established for twenty-seven
years. It has a capacity of fifty beds. Last year there
were 714 children treated in the hospital and 1317 in
the out-patient department. The hospital receives no pay
patients. There are some which pay a small amount but
the majority ti'eated are free bed cases.
Fig. 3. Makinsr the
for over twenty y
dren's Hospital.
giving motherly care to the sick babies and children en-
trusted to it, but is making thoroughly scientific diagnosis
of the cases received and giving modern, approved methods
of treatment in so far as the limitations of the hospital
■building and equipment will permit.
of the ChiUlr
The income from a very large endowment will be avail-
able thirty years hence, when not many of those who are
now laboring and struggling to make it a success will be
alive to see it, but at pi'esent writing there is only an
endowment of $150,000 to support the hospital. It is in
great need of new buildings and equipment, and there
are hopes that at the close of the war some arrangement
will be made to provide the necessary improvements.
The Children's Hospital furnishes clinical material in
pediatrics for the State University Medical School at
Columbus, and when a training school for nurses is main-
tained it affiliates with the Michael Reese Hospital of
Chicago.
Miss L. D. Atkinson, the superintendent, has had espe-
cially good preparation for her work in pediatrics. She
Fie.
rd of the hospital
Ijleasant day.
is a graduate of the Episcopal Hospital in Philadelphia
and has had training in tuberculosis work and social
service and in pediatrics at the Rockefeller Institute in
New York.
The out-patient department employs its own visiting
nurse. There are free dental clinics, and also clinics for
eye, ear, nose, and throat as well as for the usual diseases
of children. During the present shortage of nui-ses for
hospital and clinical work, volunteer workers are assisting
in Jie clinic and take the social histories of the children
admitted to the out-patient department.
The Woman's Board of the Hospital gets out a little
publication called the Bambino, from which we reproduce
some pictures of the Children's Hospital.
188
THE MODERN HOSPITAL
Q~Re
MOOEKF eOSPfTAL
EDITORIAL AND PUBLICATION OFFICE.
58 East Washington Street, Chicago.
EDITORS.
Henry M. Hurd .... Fidehty Building, Baltimore
Frederic A. Washburn . Mass. General Hospital, Boston
Winford H. Smith . Johns Hopkins Hospital, Baltimore
S. S. Goldwater . . . Mt. Sinai Hospital, New York
W. L. Babcock Grace Hospital, Detroit
John A. Hornsby . 58 East Washington Street, Chicago
MANAGING EDITOR.
M. K. Chapin . . 58 East Washington Street, Chicago
SUBSCRIPTION.
Domestic postage, $3.00. Foreign postage, $3.50 (15
Shillings). Single copies, 35 cents.
Domestic rates include United States, Cuba, Mexico,
Porto Rico, Canal Zone, Hawaii, and Philippines.
Contributors, subscribers, and readers will find
portant information on advertising page 42.
The Atlantic City Meeting
We mentioned last month some of the vital
issues to be decided at the Atlantic City meeting
of the American Hospital Association this month.
We want to emphasize once more that it is a defi-
nite duty of all hospital administrators to be
present at this very important meeting, if it is
at all possible to do so. Not only is it a duty; it
is an imperative necessity that hospital people
attend in full force, prepared to give serious
attention to the critical issues there to be con-
sidered. Moreover, Atlantic City is an ideal spot
in which to spend a week's vacation, and those
who attend will be well repaid in enjoyment and
mental and physical refreshment as well as in
the sense of duty done. The official program,
together with much other information of interest,
appears in the Special Bulletin of the American
Hospital Association, page 227.
Enrollment by Physicians Not Suspended
The War Department recently issued a state-
ment that volunteering and the receipt of candi-
dates for officers' training camps from civil life
were suspended until the pending legislation with
regard to draft ages was disposed of and suit-
able regulations drawn up to cover the operation
of the selective system under the new law. Fear-
ing that the order might be misinterpreted by
physicians, Dr. Franklin Martin, chairman of the
general medical board of the Council of National
Defense, asked the Secretary of War to issue a
statement making clear the distinction between
enlistment as a private soldier and enrollment as
an officer in the Medical Reserve Corps. Accord-
ingly, the following statement has been issued:
"Orders issued by the War and Navy Departments on
August 8 suspending further volunteering and the re-
ceipt of candidates for officers' training camps from civil
life do not apply to the enrollment of physicians in the
Medical Reserve Corps of the Army and the Reserve
Force of the Navy. It is the desire of both departments
that the enrollment of physicians should continue as ac-
tively as before .so that the needs of both services may
be effectively met."
In accordance with the request of the medical
section of the Council of National Defense, we
are glad to give publicity to the statement.
Hospitals and the Federal Inheritance Tax
The different war tax measures which have
been introduced during the war period have more
or less caused a certain amount of criticism, and
perhaps no provision will work a greater injustice
than the one which is incorporated in the Federal
inheritance tax law, now up for consideration
before the Ways and Means Committee of the
House. Hitherto, the general rule has been to
exclude from taxation all gifts acquired by be-
quests or inheritances to hospitals and other ben-
evolent institutions. In the past, this has elimin-
ated the large amount which would necessarily be
deductible from any bequest or gift as inheritance
and succession taxes on such bequest. Under the
provisions of the proposed new law, hospitals
which depend for their support wholly on priv-
ate gifts and trusts will have a major portion of
the tax to bear. The proposed law provides that,
in the event of the bequest being paid out of the
residuary estate, such payments shall not be
made until all taxes and other expenditures have
been liquidated. Under these circumstances, it
will be very easily seen that the residuary
legatee would bear practically all the expense
attributable to the proper administration of the
estate. This, of course, would not apply where a
specific bequest has been made and a certain
amount set aside for such bequests.
A strenuous effort has been made to remedy
this injustice, by legislation prepared and sub-
mitted by Mr. Rainey for incorporation with the
inheritance tax law. The whole crux of the mat-
ter is that the hospital, or such other benevolent
institution, being the residuary legatee, would not
only be paying the tax on its share of the bequest
THE MODERN HOSPITAL
189
granted it, but would also be paying the taxes of
the other beneficiaries under the will. Should
this law go into effect, there is no hesitancy in
saying that many small institutions which depend
on private charity for their maintenance and sup-
port would in a short while be forced to discon-
tinue their operations. Nothing is more expedi-
ent at the present time than that the country be
equipped with as many hospital facilities as pos-
sible, but with the passing of this law sooner
or later a contingency would arise w-hich, to
a veiy marked degi'ee, would hinder what the
government is at the present time doing its ut-
most to establish.
The legislative committee of the American Hos-
pital Association, which discusses the subject in
the Bulletin of the American Hospital Associa-
tion on another page, urges support of the
remedial legislation provided by Mr. Rainey in
H. P. 9223. The subject is one of the important
topics which is to be considered at the Atlantic
City meeting and is an additional reason for a full
attendance at that meeting.
The Dietitian in Social Welfare Service
Not so long ago home economics was a subject
about W'hich veiy little w-as know'n and to which
very little attention was given, even in the schools.
Thoughtful people, however, gradually recognized
the benefits to be derived from giving some atten-
tion to food. Now the vital part which diet plays
in physical, mental, and moral fitness has been
shown most conclusively by our medical men and
nutrition experts.
So generally is this fact being accepted that
new fields are constantly being opened to one who
has made a study of foods and nutrition. A diet-
ary department is an established part of every
modern well-organized hospital. Many wholesale
or manufacturing plants are asking women with
this training to take charge of their lunch rooms
or work with the nurse in their welfare depart-
ment, or do both. Business men realize the eco-
nomic value of having their employees so well
nourished that they are less susceptible to patho-
genic organisms which are so prevalent, and thus
a minimum amount of time is lost because of ill-
ness. We have also learned that more and better
Avork will be accomplished by a man or woman in
good mental and physical condition than by one
v\'ho is not.
Probably there is no place where there is a
greater opportunity for doing valuable construc-
tive dietetic work than in the field of social wel-
fare. The wives and mothei's in families of
limited means and of our foreign population have
no means, except through civic organizations, of
learning food values, the effect of cooking upon
digestion of food, how to care for food materials,
and how to market. Nurses as a rule are not
competent to give this instruction. In some cities
this is accomplished through a field dietitian. At
this time, when every physician left to care for
civilians is called upon to do the w'ork which in
nonnal times would be done by two or three men,
a field dietitian could give invaluable aid and
relieve him of much responsibility.
A great service is being rendered by a few
hospitals which have dietitians in their dispen-
saries. This service is of far greater value if
the dietitian can do the follow-up work in the
homes.
The League for Preventive Work in Boston has
recently opened a dietetic bureau. The establish-
ment of this bureau is due to Mr. Michael Davis,
director of the Boston Dispensary, who last year
made a dietary study of families of limited means.
Its purpose is to "bring dietetic knowledge of the
highest type, through the case workers of social
agencies down to the family of small income, in
practical, every day working form." It will give
this service to all agencies who make up the
League for Preventive Work and to other organ-
izations which may have need of this service.
Though this bureau has been opened only a very
short time, "many hospitals and dispensaries, set-
tlements, and other associations are planning to
coordinate their dietetic work with that of the
bureau." Miss Lucy Gillette, who has been con-
nected with the New York Association for Im-
proving Conditions of the Poor, is directing the
bureau. It is to be affiliated with Simmons Col-
lege, and Miss Gillette will be a member of the
Simmons Faculty. Senior students will be offered
courses including field work in the bureau.
Other cities are introducing this work to a
greater or less extent, and we expect soon to
have several contributions on the subject in the
Department of Dietetics. The Modern Hospital
would be very glad to have reports from others
who are doing a similar work, whether from
departments just established or perhaps from
those only contemplated.
Once More the Army Nursing Question
Last month The Modern Hospital based an
appeal for nurses' aids on figures prepared over
two months ago. These figures, it appears, were
too conservative. Instead of a nursing organiza-
tion of forty-five or fifty thousand women to sup-
ply an army of three million men, we need from
190
THE MODERN HOSPITAL
seventy-five to eighty thousand nurses to supply
an army of five million men. If fifty thousand
women were not forthcoming, where are we to
look for seventy-five or eighty thousand?
Evidence was presented last month that nurses
are needed now — that we cannot wait two years
to train them. Additional evidence is now fur-
nished by the army's appeal of August 7 for "one
thousand nurses per week for eight weeks in
order to provide with sufficient staffs of nurses
the American army in France." An official dis-
patch from London, dated August 13, announces
that recruiting has begun in England for a bat-
talion of the Woman's Auxiliary Army Corps, five
thousand strong, for service with the American
expeditionary forces. Must America turn to
hard-pressed England for such aid?
Officers of hospital units are authority for the
statement that there are hospital units now ready
to embark to which no nurses have yet been as-
signed. The chief of the Army Nurse Corps, in
reply to an inquiry made by the secretary of the
nursing committee of the Council of National De-
fense, explained the situation as follows : "The
male personnel is sent ahead of the female nurses
in some instances, due to transportation condi-
tions and to the required time for the equipment
of nurses." The army, the Red Cross, and any
number of public or private patriotic agencies
could, without delay, equip nurses available for
service with these units — if the nurses ^vere
available.
One of the ablest hospital administrators in the
United States, now commanding a base hospital
in France, was quoted in these columns last month
as saying that "the V.A.D.'s have certainly saved
the day in the British nursing field," and that
nurses' aids will have to help save the day in our
war nursing field. Hospitals all over the country
are preparing to train nurses' aids. Courses for
such training are inevitable. Is it not best to
recognize the fact and to standardize and regulate
the courses while there is yet time?
The Enrollment of Senior Pupil Nurses for
Military Service
A plan to relieve the nursing situation is sug-
gested by a correspondent in this issue. The en-
rollment of senior nurses in the training schools
for service in the military hospitals was one of
the first methods proposed when the need of addi-
tional nursing resources first became apparent.
If the training schools increase their forces now
as rapidly as possible by the admission of large
war classes, this program will be of great value
about two years from now and will help to meet
the situation which will then exist. At the present
time, however. Dr. Korndoerfer's scheme has one
very vulnerable point for criticism.
The enrollment of nurses for work under the
Red Cross, in the army and navy, for relief work
abroad, and for military hospitals here, has de-
pleted and is still depleting the teaching and
supervising forces of the civil hospitals. When
the enrolled nurses have gone into the service,
their places must, of necessity, be filled by senior
pupil nurses. If these senior pupil nurses were
taken, the civil hospitals would be in danger of
serious disintegration.
For instance, the superintendent of the train-
ing school of one of the largest hospitals in New
York City reports that, when she was absent re-
cuperating after an illness, the base hospital unit
of the institution was mustered into service.
With it went sixteen of the supervising graduate
nurses. On her return, this superintendent
found herself obliged to run the nursing organi-
zation of that great institution with senior nurses
in the supervising positions. What would have
been the result to that hospital if these same
senior nurses had been called to duty in the mili-
tary hospitals? This story of shortage of super-
vising graduates repeats itself from all sorts of
hospitals in various sections of the country.
From the military as well as the civil point of
view, the needs of the civil hospital must not be
forgotten. Unless our plans are comprehensive
enough to take care of the needs of both civil and
military establishments, we shall wake up later
to find that we have committed an enormous mili-
tary blunder.
A Plan for the First Unit of a Small Community
Hospital
We publish among this month's leading articles
a paper by Mr. Emmet E. Bailey, of Pittsburgh,
on the projected community hospital at Brook-
ville, Pa. We are ?alling attention to this paper
chiefly because of the thoughtful, intelligent care
which has evidently gone into its planning. It
is possible that improvements might be suggested
in the plans. For instance, we doubt the value
of storage space under the roof if elevators do
not run directly up there, inasmuch as the con-
veyance of packing boxes through the corridors
is not conducive to a restful hospital atmosphere.
And (though this scarcely comes within the
architect's province) we question the advisability
of giving so much space to laundry purposes,
since genei-al experience is against the launder-
ing in the building of the linen supply of an aver-
age small hospital. These debatable points, how-
THE MODERN HOSPITAL
191
ever, are of minor importance. After all, the
perfect hospital has yet to be built or planned.
In general, we believe Mr. Bailey's plan to be a
good one. With equally good organization and
management, the little Brookville hospital should
be able to render excellent service to the sick of
the town and surrounding countryside. We
should be glad to receive more papers in which
the architectural plans are accompanied by a
well-reasoned discussion of the considerations
which led to the adoption of the distinctive fea-
tures. This, we believe, is a very instructive
method of presenting an architectural subject.
The Future of the Civil Hospitals
The experience of Canadian hospitals furnishes
an object lesson which this country may study
with profit. The following, headed "An Appeal
for Nurses," appeared in the July issue of Recon-
struction, the bulletin of the Canadian Depart-
ment of Soldier's Civil Reestablishment :
"One of the consequences of the war is the deserted
condition of the schools of nursing. It is stated by hos-
pital authorities that the time will soon come when hos-
pital doors will have to be closed or arrangements made
whereby patients can be cared for by their relatives.
Hospital authorities are considering the wisdom of issu-
ing an extensive appeal to the young women of Canada
to take up the nursing profession by enrolling in the vari-
ous schools of nursing, most of which are conducted in
conjunction with general hospitals. So many of the
trained nurses have gone into military service that the
civilian hospitals find it most difficult to keep this impor-
tant branch of their staffs fully manned."
The Modern Hospital — Prospect and Retrospect
We announced last month the removal of our
business offices from St. Louis to Chicago. It
may be of some interest at this time to explain
just what this change means to The Modern
Hospital and its readers.
The consolidation of the editorial and business
offices of The Modern Hospital under one roof
and certain other changes consequent on or
coincident with that centralization are the result
of plans running back almost to the time of
the foundation of this journal. Some of these
plans are now in the process of fulfillment ; we
still look forward to the realization of others.
The Modern Hospital is developing along the
lines laid down for it at its inception ; it has
changed only in the sense that everything alive
and growing must change.
We mentioned last month the double advantage
which was expected to accrue from closer co-
operation between the editorial and statistical
departments. It has been the aim of the statistical
department to serve the hospitals by furnishing
any information that may be useful to them. The
data on the hospitals of the country, their bed
capacity, character of work done, connection with
training schools, etc., compiled by Mr. H. T.
McClure, head of this department, are more com-
plete and trustworthy than any to be found else-
where. The stati.stical department has had the
privilege of furnishing data on the building of
hospitals to the medical section of the Council of
National Defense ; of collecting for the Red Cross
information with regard to hospital executives
available for war service ; and of furnishing in-
formation to the American College of Surgeons
for use in its hospital standardization campaign.
Several of the departments of The Modern
Hospital are planning extensions of activity. In
the Department of Nursing, Miss Goodrich, whose
time and energies are naturally absorbed to a
considerable extent by her duties as dean of the
new Army School of Nursing, has felt the need
of a coadjutor, and Miss Carolyn E. Gray, prin-
cipal of the City Hospital School of Nursing, New
York City, has accepted this position. Miss
Graves, editor of the Department of Dietetics,
intends soon to inaugurate a new feature which
will, it is believed, very greatly increase the value
of this department to its readers. She will
answer questions of general interest to dietitians,
superintendents, etc., through the columns of this
journal. The Department of Industrial Welfare,
under its editor, Mr. Barrow B. Lyons, superin-
tendent of Delaware Hospital, will take up many
important questions. Mr. J. J. Weber, recently
appointed eastern editorial representative of The
Modern Hospital, is giving special attention to
New England hospitals and dispensaries.
Dr. Hornsby and several of his associates on
the editorial board are for the present devoting
themselves to the service of the government. It
is, of course, a privilege for The Modern Hos-
pital, not less than for the individuals concerned,
to be permitted to make some sacrifice for the
common cause ; even if it meant being deprived
altogether of the invaluable guidance of these hos-
pital experts, we should have no right to do
otherwise than cheerfully and gladly to resign
our claim to their services. Fortunately, how-
ever, this degree of abnegation has not been de-
manded of us ; we are still able, from time to
time, to avail ourselves of their advice and coun-
sel. The policies of The Modern Hospital,
consequently, are still directed by members of
the ditorial board.
The summons into government service of mem-
bers of the editorial staff has, however, accent-
uated a condition which existed previously and
192
THE MODERN HOSPITAL
has hastened the application of a remedial
measure. With the growth of The Modern Hos-
pital, it had become increasingly difficult or
impossible for Dr. Hornsby to give his personal
attention to the multitude of details connected
with the editing of the journal, and his more or
less proti-acted absences from Chicago on govern-
ment service seemed to require the appointment
of a managing editor, to conduct the details of
editorial affairs. Miss M. K. Chapin, previously
associate editor, has been appointed to this post.
Many other interesting new activities or ex-
tensions of old activities are contemplated, and
further announcements will be made from time
to time.
Spontaneous Combustion of Coal
Spontaneous combustion of coal usually occurs
in very fine coal, or coal with a great deal of
dust and fine particles in it. Chestnut, pea, or
any well-screened coal does not ignite, nor does
coal which is so spread out that the air can pene-
trate freely to all parts of the pile. As war con-
ditions have made it necessary for users of coal to
take what they can get, and as storage space in
cities is limited, spontaneous combustion is likely
to occur frequently, and, in fact, we understand
that fires from this cause are increasing. Hos-
pitals and other institutions should watch the
temperature of their coal piles. The fire depart-
ment of the city of Chicago has offered its serv-
ices free to coal users, who are invited to report
any suspicious rise in temperature. No doubt the
fire departments in other cities would be equally
glad to cooperate for the prevention of fires.
Wanted — Stories of Hospital Life
We have long wished that The Modern Hos-
pital might be instrumental in encouraging hos-
pital people to write some of the incidents — amus-
ing, pathetic, or dramatic — of institutional life.
A few of these are recorded in the series of
"Memoirs of a Head Nurse," which began in the
June issue of this journal. Every hospital, how-
ever, has its stories. We would like to receive
these narratives from institutions all over the
country, and we desire especially to hear from
nurses. While we do not place any absolute
limitations of length on contributions, from five
hundred to a thousand words will be an acceptable
average length. Names, of course, may be
altered, and incidents disguised if they would give
a clue to identities. To mark our appreciation,
we shall be glad to credit the author of any article
accepted with a year's subscription to The Mod-
ern Hospital.
To all who may know interesting tales of hos-
pital life, but who are reluctant to write because
their previous experience has been practical
rather than literary, we wish to say : The story's
the thing; let it tell itself; never mind the fine
writing. And, in sending it in, please indicate
whether the writer is a superintendent, a physi-
cian, or a nurse, and, if a nurse, whether graduate
or undergraduate. These particulars will not af-
fect the acceptance of the article ; the information
is asked for merely as an item of interest.
THE LATCHSTRING OUT
The Modern Hospital will take great pleasure in being
of service to out-of-town hospital people on their visits
to Chicago. We hope that our friends will come to us for
any information that we can supply in regard to the city
or in regard to local hospitals. News which they can
bring us in regard to work in their own communities is
of interest to our i-eaders, and will be published in this
column from time to time.
A WONDERFUL work for the blind was lately described
to us by Mrs. Sidney McCallin, an American recently re-
turned from London, where she served for over a year on
the staflf of St. Dunstan's Hostel. There is nothing like
St. Dunstan's in the world. It was founded by Sir Arthur
Pearson, the publisher, who is himself blind; it embodies
the new ideas with regard to those who have lost their
sight.
Mrs. McCallin says that, when she first became a mem-
ber of the staff of St. Dunstan's, she was surprised to find
Fig. 1. Members of the staff of St. Dunstan's Hostel.
that she was not depressed by association with these un-
fortunates. "Am I growing callous and unfeeling?" she
asked herself. On analyzing the situation, she found that
the men themselves were the happiest crowd with whom
she had ever come in contact. They do not regard them-
selves as objects of pity; far from it. "I'm not handi-
capped, sister; I'm only blind," one or another would say.
St. Dunstan's Hostel (not hospital) receives the men
after their physical rehabilitation is complete, and shel-
ters and trains them until they are ready to go out into
the world as self-sustaining members of society. They
usually remain about a year, but they may ^tay longer.
THE MODERN HOSPITAL
19-^
Because they are no longer subject to the distractions
which enter through the avenue of sight, they learn much
more quickly than do persons who see, and, when they
leave St. Dunstan's, they are often prepared to earn a
better living than when they had their sight. They are
Fig. 2
not, however, flung overboard to sink or swim; St. Dun-
stan's still has a watchful eye and a friendly hand for
all of its graduates. Mrs. McCallin has kindly written
something for The Modern Hospital about her work at
St. Dunstan's, which will appear in an early issue.
Kans.^S is living up to its progressive reputation, re-
ports Dr. Lydia Allen DeVilbiss, chief of the division of
child hygiene. State Board of Health, Topeka. The two
most important pieces of work at present being accom-
plished by her division are a state-wide house-tc-house
canvass of mothers and a centralization of the care of
dependent children. The five-blank system is used in the
state-wide canvass of mothers. The first blank is for the
mothers who wish to receive the Kansas Mothers' Book
free; the second, in regard to the birth registration test;
the third is the pre-natal blank (the expectant mothers
receive a series of nine monthly letters from the State
Board of Health) ; the fourth, information concerning the
care of crippled, defective and dependent children ; and the
fifth, in regard to communicable diseases. Two counties
have already been covered by the canvass and it is being
carried on in twenty others.
Incidentally, Dr. DeVilbiss says that Kansas has gone
further than most other states in its clean-up for the
benefit of the young soldier. Kansas quarantines not only
women, but men, affected with venereal diseases.
Mr. John G. Bowman, director of the American College
of Surgeons, who has recently returned from a trip
through eastern Canada, has brought back very favorable
impressions in regard to Canadian hospitals. Canadian
hospital adminis'trators, according to his observation, are
most desirous to improve and welcome constructive sug-
gestions. Many of the hospitals under the direction of
various sisterhoods show most creditable progress.
Mr. Bowman reports that the American College of
Surgeons will call a conference of Fellows of the college
and leading hospital administrators to be held in New
York in October, at which the work already done by the
college will be reported and plans worked out for a
further campaign.
Dr. Hugo Ehrenfest, of St. Louis, says that the war
has caused the usual amount of disorganization in the
City Hospital of St. Louis. The service there was or-
ganized in three units, one-third of the patients being
allotted to Washington University, one-third to St. Louis
University and one-third to unattached physicians. This
third unit has been practically broken up. Dr. Ehrenfest
believes, however, that there is no need to be pessimistic
about the future of the civilian population; the patients
who really need care will be taken care of, while those
who have indulged in the luxury of a physician and a
nurse for every trifling ache or pain will have to do
without.
Mr. Joseph Purvis, superintendent of West Suburban
Hospital, Oak Park, 111. (described in the "Field Editors'
Notebooks" for August), has recently accepted an adminis-
trative hospital position with the American Red Cross,
and expects to be assigned to duty soon.
Why Hospital Standardization?
There are in New York quite a number of small hos-
pitals fashioned out of one or more of the old brick or
brownstone front rows in the older part of the city. Some
of these are hardly up to our present ideas of sanitation
or efficiency. Recently an investigator reported conditions
in one of these institutions which we believe will show as
good a picture of the hospital standard as any end-result
or case record. In one small room were found three crib
beds. The first contained a new-born baby, so new that it
had not yet had its first bath; the second held a child who
had a bad case of erysipelas, and on the third was laid to
dry a batch of noodles for that day's dinner!
Building of Permanent Tuberculosis Hospitals Approved
"The National Tuberculosis Association announces,"
says a recent issue of the Suri-ey, "that there is pressing
need throughout the United States for an immediate in-
crease of hospital facilities for the tuberculous. It is
cooperating with the Capital Issues Committee of the
Federal Reserve Board to secui-e the necessary capital.
To allay uneasiness in certain quarters, this board re-
cently announced that, in spite of the necessary conserva-
tion of the capital for war purposes, the building of hos-
pitals will not be limited to temporary structures, but
that investments in permanent structures will be ap-
proved if the difference in costs is not too large, or if
special circumstances make them more desirable."
Saving in Adoption of Food Administration Measure
The Michigan State Prison reports large savings in
feeding its twelve hundred inmates through adoption of
Food Administration measures. There are two meatless
and wheatless days every week, according to the report of
Steward G. W. Wenzel to the Michigan Federal Food
Administrator. Fifteen per cent potatoes are used in
baking wheat bread, and this has been found so satis-
factory a substitute for wheat flour that the percentage
is to be increased. Some difficulty was found in purchas-
ing cereal substitutes, so the prison bought a carload of
corn and installed a mill for grinding meal.
He who sincerely serves his country leaves the
fragrance of a good name to a hundred ages; he who does
not leaves a name that stinks for tens of thousands of
years. — An Emperor of China.
194
THE MODERN HOSPITAL
THE GLENNAX ADJUSTABLE BUNK
A Comfortable Hospital Train Bed for the Sick and
Wounded — Flexibility of Adjustment
By harry N. kerns. Major Medical Corps, U. S. A.
The transportation of sick and wounded presents no
problem more difficult than that of providing for the unex-
pected. The two questions which will always be asked
by the transportation division are, "What kind of accom-
modation is needed?" and "What amount will be re-
quired?" It is true that experiences gaii>ed from recent
warfare have taught us to expect a certain percentage
of the total number engaged in battle to result in casual-
ties, and we have
further learned
that these casual-
ties may be divided
into three types:
(a) those able to
walk, (b) those re-
quiring ambulant
transportation, and
(c) those who
must be transport-
ed in the recum-
bent position. As
to the relative pi'o-
portion in which
each one of these
three types of cas-
ualties will be en-
countered, we may
make a forecast,
but our estimates
are at best only
approximations
and, as such, are subject to very wide variation. Trans-
portation facilities, then, must be so flexible as to meet
any demands which ever-changing conditions may indicate.
In the field, our problem has appar-
ently been solved by the ambulance.
Both the motor-driven and animal-
drawn vehicles are so equipped as to
provide for either the lying or sitting-
patient.
The next link in our line of commu-
nications is the hospital train. Here
it may be suggested that the Pullman
section, with its readily convertible
features, should meet all requirements,
and for the convalescent case it is
really ideal. But for the bed case the
Pullman berth leaves much to be de-
sired. Furthermore, the constantly in-
creasing demands of troop transporta-
tion in this country have drawn heav-
ily upon the available Pullman cars, so
that to withdraw them in any consid-
erable number for use of Hospital
Trains would be to embarrass troop
movements.
Some scheme had to be devised em-
bracing a convertible bed, one which
could be used for either recumbent or ambulant patients,
and which could be readily applied to any type of car: the
Pullman car, the ordinary day coach, or the freight car.
To meet this situation. Col. James L. Glennan and
Lieut. -Col. William L. Hart have devised an adjustable
'iff. 1. The Glennan bunk in position in
which it will onlinarily be used for re-
cumbent patients.
Fig. 3.
Glenn
bunk. The mechanical details were worked out by the
Simmons Metal Bed Company.
In a general way, this bunk corresponds to the one now
in use on the British hospital trains, but many changes
and improvements have been made.
The Glennan bunk is capable of four adjustments, all of
which are shown in the accompanying illustrations. It
will be seen that the vertical steel stanchions which sup-
port this bunk are applied to the wall of the room. They
may be applied to the side of a car in the same manner,
irrespective of window spacings.
Figure 1 shows the position in which it will ordinarily
be used for recumbent eases. As the bed is but 2% feet
wide, it seemed
desirable, particu-
larly in the case of
the "upper," to
provide a retain-
ing strap which
would safeguard
the patient from
falling out. The
position and at-
tachments of this
strap are readily
seen in the picture.
An ordinary wood-
en head-board has
been provided. This
is partially ob-
scured in the illus-
tration by the pil-
low, for which it
forms a support.
Figure 2 shows
the bed dropped to
a more convenient
mid-elevation for cases requiring extensive dressings or
other special treatment. The bed in this position is 36
inches high. The lower bed will be seen
folded up out of the way.
A sofa position is shown in Figure
?>. Here the upper bed is simply
dropped down to form the back rest, no
adjustment being necessary for the
lower bed, which forms the seat. The
mattress, secured to the springs by
straps, forms the back of the sofa. In
the other positions the same straps
serve to retain the patient. The sofa
will comfortably accommodate three
ambulant patients, though for long
trips it is not recommended for more
than two.
When not in use, both beds may be
folded up against the side of the car to
facilitate cleaning' (Fig. 4).
The bed itself may be completely de-
tached from its supports and used as a
litter, should such procedure be indi-
cated in the transportation of those
patients so seriously ill that the mini-
mum of handling is desired.
The adjustments required in the con-
version of the Glennan bunk into its various positions are
easily and quickly made. Two men are required for this
purpose, but, after a little practice, it is believed the
changes may be made more quickly than in the case of
a Pullman.
Fig. 2. The bunk with the bed dropped to
a more convenient elevation for cases re-
quiring e.xtensive dressing or other such
treatment. The patient is using the Hart
server.
sofa posi-
tion, the upper bed being dropped di
to form the back rest. The two pa-
tients are making use of the Hart and
the Travis servers.
THE MODERN HOSPITAL
195
To provide for the serving of food to patients in this
bunk, an arrangement has been devised by Col. W. L.
Hart, M. C, to take the place of the medical department
"tray with legs," the latter having proved quite unsatisfac-
tory on Hospital Train No. 1. The Hart "server" consists
of an ordinary tray fastened to an inverted L-shaped
supporting rod, the vertical leg of which is shaped to fit
snugly into a tapering square hold on the side of the bed.
It may be used for either bed or sofa, by simply rotating
the L rod 90 degrees on its vertical axis so that the trav
may be brought aci-oss the bed or over the edge of the
sofa. The tray itself may be converted into a book-rest
for the I'ecumbent patient by rotating it 45 degrees on
the horizontal axis. Figure 3 furnishes a very good idea
of the varied uses of this server, while
Figure 4 shows the way in which the
beds may be folded up when it is
necessary to clean the car.
The Glennan bunk has been put to
the test of actual usage on two occa-
sions in transportation of overseas sol-
diers convalescent from serious wounds.
These cases were of varying type and
severity, and, while the bunk appeared
to meet the needs of each in a satisfac-
tory manner, more extended use will
undoubtedly indicate lines along which
improvements may be made. It is not
as comfortable for the ambulant case
as the Pullman section, but it is vastly
more flexible, and the accommodation
it provides for the recumbent case is
almost as good as that of the standard
hospital bed. It is substantially built,
relatively cheap, and may be readily
installed in barracks, hospital, ship,
or any type of railroad car. It em-
bodies a degree of flexibility which will
go a long way toward providing for the unforeseen.
A SIX HUNDRED-BED HOSPITAL TENT PREPARED
IN TWENTY-FIVE DAYS
Site Was Once a Race-Track for Sport, Now a "Wayside
Inn" of Alercy — Regular Hospital Conveniences
Offered at the Front — Tents Easily Trans-
ported as Troops Are Moved
By FORBES WATSON of the American Red Cross, Paris.
It took the American Red Cross just twenty-five days to
transport a 600-bed hospital to a once famous race course
near the front, and set it up ready to receive the wounded.
At three o'clock on the morning of the twenty-fifth day,
ambulances began to arrive with gassed Americans, and
To those who have not visited the modern army tent
hospital, such an institution may seem to be a kind of
makeshift where the wounded soldier is taken care of as
well as the circumstances permit, but is not really get-
ting the benefit of a complete hospital installation. This
is an entire misconception. The tent hospital is not a
casual incomplete aff'air. It has a steam-heated operat-
ing room which can be placed on a specially made truck
for rapid transportation. It has a complete sterilizing
plant also attached to a trailer which is pushed up to the
operating room in such a manner that the sterilized in-
struments can be passed from the nurse to the operating
surgeon without loss of time. It has a fumigating plant,
shower baths for wounded able to take baths themselves,
bath-tubs for those so sick that they
have to be given their baths, a com-
plete electric lighting system, and
stoves to keep the wards warm in cold
weather.
It is divided into wards of twenty-
four beds, each ward being 60 by 20
feet, and there are covered connecting
passage-ways wherever necessary. The
kitchen equipment is complete for pa-
tients and personnel. And, finally, the
wards are cool in summer and warm in
winter. The tents are the well-knovvm
Bessonneau type, with windows that
make them light and airy, and an air-
chamber between the two coverings of
the tent. This hospital is as comfort-
able for the men as a permanent in-
stallation.
Hospitals of this type are known as
autochirs, a word that has been coined
and is now generally used, being a con-
traction of the two words "automobile"
and "chirurgicale." Generally they are
divided into units of two hundred beds which can be
moved on eighteen trucks. When all the items of equip-
ment are properly packed and in the right places and the
personnel are trained in the work, they can be set up with
about the same speed as a circus. The illustrations indi-
cate the type of hospital resulting.
In fact, the great advantage of the tent hospital is the
speed with which it can be installed and removed. When
used at the front, it is pushed forward to the farthest
practical point, and in case of a withdrawal of troops, it
is possible to move the hospital back before it is captured.
Similarly, when there is an advance, it can be moved up
toward the new lines.
But when the Red Cross establishes a tent hospital,
such as the present, the object is to supply an emergency
flooring: and canvas for a tent hos]>ital which
n Red Cross completed in twenty-five days and
turned over to the Army Medical Corps.
before the close of the day, one hundred sixty wounded
were being cared for. The work was done at the request
of the United States Army, and the hospital has been
turned over to the Army Medical Corps.
FiB. 2. This hospital for six hundred American soldiers was
ready for patients twenty-five days after the site had been
selected.
demand for hospital accommodations. However, there is
no expectation of hurried moving, so that permanent bar-
racks of various kinds supplement the tent installation.
Tents are economical in time, and last for two or three
196
THE MODERN HOSPITAL
years, if kept in the same place, but after tliey have been
subjected to the weather for six or eight months in the
same place, they cannot be moved without a good deal of
wastage, due to shrinking, stretching, etc.
The present hospital is not for serious cases; it is used
for those that can be evacuated in ten days or two weeks.
They are either sent back to the front, cured, or evacuated
fui-ther south to hospitals for long cases. The wounded
coming to this hospital have already been treated at a
base or field hospital, and then moved to make room there
for other incoming wounded. It would be a waste of time
to send men who will soon become effective to hospitals
distant from the front. At the same time, it is a cardinal
principle of army hospitalization to guard against any
chance of having base and field hospitals overcrowded in
times of crisis. Hence the half-way station, which is what
the present hospital might be called.
The present location is ideal for such a hospital. On
a piece of ground surrounded by woods, the land is high
enough and sunny enough, yet all about there are com-
fortable shady places for the boys who can move about.
One who was there yesterday had taken part in the suc-
cessful attack on Cantigny. He was the victim of a gas
attack, but a mild case, and when Cantigny was mentioned,
he grinned.
"Yes," he admitted with his face almost submerged in
a big bowl of milk, "we licked 'em."
And there was another boy who was wounded by a
machine-gun bullet which had just touched the tip of his
nose and gone through his clothes at two different places
without doing any more damage. He wore two wrist
watches. The one on his right wrist belonged to his
lieutenant who was shot at his side. Just before being
shot the lieutenant said: "Bill, if anything happens to me,
take care of my wrist watch"; and Bill did.
Very different is the chance these men are taking from
the chance that the men used to take in this field. Yes,
the old betting booths are still there, but they are filled
with bales of hospital supplies, and the little thatched-
roof meeting place for bettors is now a smoking and af-
ternoon-tea pavilion for United States army convales-
cents. The hurdles are almost hidden in the tall grass.
The names of the horses are washed off the betting
board, but the race-course never had as many thorough-
breds as it has today. And the thorouglibreds, being
United States soldiers, are exactly the kind that the Am-
erican Red Cross is most interested in taking care of.
THE MEMOIRS OF A HEAD NURSE
IV. Peter Koksovidus — The Operating Room Supervisor
Tells This Tragedy of the Police Ambulance
Bill Black was standing by the big window in the long
hall that led into the emergency rooms of the operating
wing. The window was just opposite the elevator and
looked down into a court where there was a cement in-
cline to the ambulance entrance.
Bill was initiating a new orderly in the proper methods
of receiving emergency cases. He was always appointed
a committee of one to pass on the applications for ad-
mittance of orderlies to the fellowship of the operating
rooms, and his judgment never failed.
After two or three days' trial of each new man the
supervisor would ask, "What do you think of that new
orderly, Bill?" and Bill would invariably give one or the
other of the two following answers: " 'E's h'absolutely
'opeless, miss," or " 'E's a poor nut, miss, but if ye gives
me time, I thinks as 'ow I can get it through 'is dome."
Besides his native cockney English dialect. Bill pos-
sessed a good vocabulary of one other, the most forcible
and expressive dialect known to any language, American
slang, and he used it whenever and wherever possible.
The new orderly was listening attentively to his in-
structor. "Listen," said Bill. "When the h'ambulance
whistle is blowin' nice an' easy, ye don't 'ave to 'urry
yerself, but when she comes the way she's comin' now
like h'all 'ell was let loose, she's got a bad one inside.
Watch for yer h'elevator. Sometimes she don't come up
at all. Then yer know it ain't no use, they takes 'em to
the morgue. Stand by, this time she's comin' up."
The elevator door swung open, and out came two
police ambulance men carrying a stretcher, on it a gray-
faced, dark-eyed laborer in overalls. His life was oozing
through the thick canvas of the stretcher, wetting the
policemen's shoes and leaving a red trail on the white-
tiled floor.
I think I shall live to be very old before I can forget
Peter Koksovidus. Peter was a Greek with a profile as
clean-cut as a marble head of Apollo. He had thick black
curls and wonderful chest muscles. Most of Peter we put
on the emergency table; the rest of him was in his boots
which the motorcycle policeman was carefully setting on
the floor. Peter had tried to cross the tracks in front
of a Grand Trunk switch engine.
For once there were plenty of interns on hand. The
shrill shrieking of the ambulance whistle had brought at a
run even those who were having their afternoon naps,
or talking in corners to their favorite nurses.
Someone had called the office for one of the staff.
The senior surgeon himself happened to be in the house
and came up — a great surgeon, a kindly and courteous
gentleman of the old school. He stood at a distance
from the table with his hands in his pocket. I wondered
then why he did not put on a gown and help us or suggest
something. I know now that he saw at a glance that
our work would be for nothing, but he liked to watch us
while we made the good fight.
The resident physician stood on the left of the table
giving a subcutaneous saline in the breast. I was on the
right giving hypodermics about as fast as a nurse could
get them ready for me, but in spite of all this, and in
spite of the good, quick work that two junior interns
were doing, tieing the bleeders, lucky Peter was going
out, slowly but surely, under our hands, saying over and
over again just one Greek word I couldn't understand.
I asked the interpreter what he was trying to say and
he answered, "Oh, he just say, 'why?' 'why?' all the time."
The senior surgeon said to a group of interns as he
passed out the door, "To do emergency surgery one has
to be something of a philosopher. Good night, gentle-
men."
MENTAL HYGIENE AND THE WAR
.Mental as Well as Physical Preparedness Provided for in
Our Government's War Program
By ETHEL ANDERSON PRINCE, Assistant Secretary, New York
Committee on Feeble-Mindedness, New York
Some years ago there was coined a term which today
is firmly established even in the vocabulary of the lay-
man. Theoretically we have long believed in mens
Sana in corpore sano, but it remained for the last decade
to see mental hygiene standing shoulder to shoulder with
widespread endeavors for nation-wide physical and moral
betterment. It was inevitable that it should be so; for
if we grant one of our final goals to be an ever-increasing
social adaptation, certainly we must recognize the part
THE MODERN HOSPITAL
197
played by mental factors in cases of failure of adjust-
ment and guard against them. We have long i-ecog-
nized the preponderance of those factors in work with the
mentally sick. Of late we have realized the necessity for
constantly applying our wider knowledge of the mechan-
isms of the mind in any organized prophylaxis — in the
school, the factory, the juvenile courts, the prison. And
today, because therein are mingled all the varied factors
of human behavior, all potentialities for future good or
ill, we must admit a new and challenging sphere for
mental hygiene — the great war.
For the first time in the history of the world a nation
has gone into war with a realization of the need for
mentally, as w'ell as physically, fit soldiers. Success has
always been predicated on strength. The leaders of a
people have ever included in that category physical
strength and that definition-eluding spiritual strength, or
morale. The great war has added another prerequisite
to victory — mental strength — without which neither of
the other two avails.
It was a source of much gratification to mental hygiene
workers generally when it became apparent that the gov-
ernment was fully pledged to a war program which in-
cludod provision for mental as well as physical prepared-
ness. This program was largely the result of the most
intensive kind of preparedness on the part of the National
Committee for JNtental Hygiene. In April, 1917, a war
work committee was established with Dr. Thomas W.
Salmon, the medical director of the national committee,
as chairman, Dr. Pearce Bailey and Dr. Stewart Paton
being the other members.
In May, 1917, Dr. Salmon went abroad and made a
special study of the war neuroses and mental disorders
in the British Army. His report has been of utmost
and basic assistance to the Surgeon General in making
plans for psychiatric work in the American Army. A
division of psychiatry, neurology and psychology in the
Medical Corps was created with a three-fold purpose — to
eliminate from the service the mentally and nervously
unfit, to provide for the care and treatment of cases of
potential and actual incapacity, and to undertake the
problem of reconstruction and return to the army or
civil life of the mentally or nervously disabled. Col.
Pearce Bailey is director of the division, with Maj. Robert
M. Yerkes as head of the psychological section. Dr.
Salmon, with the commission of lieutenant-colonel, is in
charge of the neuropsychiatric work of the American
expeditionary forces in France.
At once there was a fundamental need for psychiatrists
and neurologists, and the call has been answered up to
date by about four hundred and fifty men, who have in
most cases taken out commissions for the duration of
the war and are ready, the pick of the profession, to
officer this line of defense. Some have gone overseas
with base and evacuation hospitals, some are in charge
of instruction work here, while others are looking after
returned soldiers suffering from nervous disorders. Each
cantonment base hospital is supplied with a neuro-
psychiatric ward, and in addition five larger psychopathic
hospitals have been established in the areas of densest
military population. A thousand-bed special base hos-
pital for war neuroses has been established in France.
A large number of the officers in this division are en-
gaged in running the machinery of exclusion from the
army of the mentally and nervously disabled. This is
the popular appeal. We have read much of "instantan-
eous mental diagnosis" in the current dailies. Formerly,
to the lay mind a mental examination sounded like either
a pleasantly innocuous game or a series of absurdities.
But the public has become accustomed to the idea and on
the whole more tolerant. We could hardly ignore the
fact that up to July 1 of this year twenty-two thousand
men have been recommended for discharge from our army
for mental or nervous troubles or detailed for domestic
service only.
It was evident, with this great number excluded from
our available fighting strength, that we must take some
strong measures for prevention in the case of the po-
tentially psychotic and neurotic and for treatment for Lne
actually incapacitated. Special neuropsychiatric wards
have been established and attached to base and evacua-
tion hospitals. A skilled nursing personnel has been
recruited, as well as expert occupational and special
workers for reconstruction work with returned cases.
Effort to get the various states to cooperate in caring
for the men returned from camps as unfit for service so
far has enlisted the help of forty-four states.
That mental hygiene is a practical necessity, in war as
in peace, is becoming more established in public thought.
Smith College is off'ering a course for the intensive train-
ing of "psychiatric social woi'kers" with special reference
to occupational and reconstruction w-ork with mentally
disabled soldiers and their families, but with a larger
future program in civil life. The women in training as
nurses at Vassar College this summer are being given in-
struction along lines of mental as well as physical hy-
giene. Courses embracing this field are announced for the
summer session at Columbia University, including occupa-
tional therapy, social investigation, etc.
The increase in abnormal mental manifestations during
war is very marked. We were somewhat accustomed
to the size of the figures in peace times; we knew that
we must expect fifteen hundred insane a year from an
army of half a million in days of peace. We know
today from the statistics of our allies that we must ex-
pect over three times that number from half a million
sent on the field. Even tuberculosis does not approach
mental disorder in its importance as cause of permanent
disability in military service. The unparalleled condi-
tions of strain and stress produce an unprecedented num-
ber of insane and neurotic. Even during the summer of
1916 when our troops were on the Mexican border mental
disorders led in the causes of discharge. In the Canadian
Army mental disorders represent one-tenth of the total
casualties. British statistics show that mental and func-
tional nervous diseases are responsible for not less than
one-seventh of the discharges for disability from the
army, or one-third, if the wounded are excluded.
In peace times mental disorders among troops show a
fairly high rate of recovery, and in the war neuroses
even a greater degree of quick return to normal seems
to be present. This is especially true of the so-called
"shell-shock." But while admitting this optimistic proba-
bility, we must realize that only in immediate treatment,
if possible within the sound of artillery, lies our best
chance for good results. We must have not merely ade-
quate detention facilities at base hospitals; we must have
first-rate psychiati'ists and nurses. The first desideratum
in the eyes of the commanding officer at present is natur-
ally to get a disabled man back into the trenches. Hence
prompt and efficient treatment at base or field hospitals — •
which results often in immediate return to the coloi-s.
For, especially with the functional nervous disorders,
give " the right kind of first aid, recovery is sometimes
instantaneous and complete. Failing that, there is the
special overseas hospital with wards for nervous and
mental cases, followed by care at a special convalescent
camp. Returns to the ranks may be made from here.
198
THE MODERN HOSPITAL
But inevitably some patients, either incurable or requir-
ino- longer treatment, must be sent home. So there is a
need for a clearing house at the port of entry where
cases may be classified, social investigations carried on
and adequate measures for disposition in general or
special hospitals, convalescent camps and re-education
centers taken.
It is not merely what the war has done for mental
hygiene in public acknowledgment, as one writer puts it,
"that mental hygiene has 'arrived,' that organized work
to promote mental health is no longer an experiment, but
has become a vital part of all public health work and is
contributing to national stability and supremacy." Here
we have direct evidence of the value of what mental
hygiene has done and is doing for the war. With emo-
tions strained taut to the breaking point, with constant
need for action, demanding the keenest mental and bodily
reactions, we are realizing that the goal of victory de-
pends not only on the physical stamina of him who runs
the race but on the brains he possesses also.
But while we are striving to give the best that is in
us to this world-wide struggle for the safety of democ-
racy, we must not fail to keep our program for the future
ever clear before us. We have a two-fold task imposed.
First win the war, then, and no whit less urgent, we must
prepare to assist in restoring conditions favorable to
normal thought and action. And since the democracy we
hope for includes a milieu sane and healthy, we must pre-
pare for a more efficient and intelligent organization of
social forces than we have heretofore seen. We may
find it a far more challenging task to successfully prose-
cute the right kind of peace than a successful war.
THE TRAINED ATTENDANT*
The Problem of the Small Hospital— The Trained Attend-
ant Versus the Untrained Practical Nurse
By FLORENCE DAKIN. R.N., Superintendent Miiklletown Hospital,
Middletown, Ohio
That there is an absolute necessity for meeting the
present need for nursing care is evident. Any plan which
may assist in solving this vital problem should be con-
sidered with an open m.ind, and all suggestions should be
thoroughly investigated before being condemned.
One particular branch of hospital training, that of the
trained attendant, offers one solution. Up to the present,
trained attendants have been connected chiefly with short,
theoretical courses given in insane asylums, homes for in-
curables or convalescents, or special institutions, such as
eye and ear hospitals.
It is the employment of the attendant in the general
hospital that I wish to emphasize, and I would like to
explain that statement at once so that it may not be
misunderstood. We have two great classes of people
who do nursing — the trained or graduate nurse and the
untrained or practical nurse. The latter is as essential
and important as the former, and has as necessary a work
to do; perhaps, in a way, more, since the lives of those
who employ her are often jeopardized by want of care, or
misdirected care.
Many of those who require or prefer practical nurses
are not able for various reasons to go to hospitals, par-
ticularly when there are none very near, even if they
could afford to do so. Mothers cannot always leave their
families uncared for and cannot or do not wish to send
♦Read at the annual meeting of the Ohio State Hospital Association,
Columbus, Ohio, May 28, 1918.
their children alone for hospital care. The practical nurse
is best adapted for such cases, particularly when the
duties entail a little housework, perhaps, or the absence
of modern conveniences. Then, also, in country cases, the
country practitioner is frequently unused to the graduate
nurse and advises the practical nurse, as conforming
more to his desires as well as to those of his patient.
So, whether we will or no, we have the practical nurse
with us, and she always will be with us, with her good
or bad experience instead of training, until we can pre-
sent a proper substitute.
The term "trained attendant" is aptly chosen, for while
it does not transgress upon the ideals incorporated in the
word "nurse" — those ideals which we wish to and must
keep intact — it implies that there has been training under
supervision. The number of so-called correspondence
schools is overwhelmingly large, and the type of woman
"who does nursing for Dr. So-and-so" abounds. In 1917
there were over seven hundred of these women in New
York State alone. The crying need of the great war
nursing problem has brought into existence another class
— the nurse's aid or untrained woman who can give per-
haps a few months to a short course of training.
Before arriving at my point I must speak of training
schools in general and those connected with small hos-
pitals, in particular. The higher educational standards
the former maintains the better, and even the visioning
outline of the future university training center, as sug-
gested at the recent nurses' convention at Cleveland.
Ohio, by Col. Winford H. Smith, reveals to us not only a
possibility but a reasonable probability as well. We can-
not have too high an ideal for our profession, but we must
not blind ourselves to what we are leaving behind when
we are on the upward trend.
The large schools are being better and better equipped.
More resident instructors are installed, and larger oppor-
tunities are given to the pupil nurse. All these improve-
ments bear directly upon the small hospital with its
training school of from six to fifteen nurses. The small
hospital, in many states, has to meet its lack of service
by affiliation with larger schools and, therefore, has to
support more nurses than it is using for its own need.
The larger schools have so much more to offer in
service, equipment, and instruction, that there is a short-
age in applicants in small hospitals, though often the
requirements, educational and otherwise, are the same.
This brings us to two vital questions. The first is:
Should we urge young women, who are qualified to meet
higher requii-ements, to give two or three years of their
lives to an institution which cannot provide training suffi-
cient to equip its graduates for institutional work or pro-
vide a field for private practice, and which compels its
graduates in a struggle for a recognized place to take a
post-graduate course in a better-known hospital? It is
certainly not fair to the young woman herself, for we
are thereby, pei-haps unconsciously, depriving her of the
opportunity she should have, if she has the required
qualifications and if she is willing to give the time and
strength to her profession.
The second question is: Is it fair to the larger schools
(in hospitals of from fifty to one hundred beds and
upwards) to reduce their number of applicants by supply-
ing qualified applicants for these numerous small schools
which exist all over the country? The very large hos-
pitals and well-known schools are perhaps never short of
applicants, particularly at the present time; but there
are as many, if not more, medium-sized schools which find
it difficult to keep up their required quota of probationers.
THE MODERN HOSPITAL
199
"A house divided against itself cannot stand," you
know, and it certainly seems as if we were buildin;!: up
with one hand and depleting: with the other, when we
advocate the highest and best possible training opportuni-
ties for young women, better and bigger schools, and
more far-reaching service, and at the same time main-
tain the multitude of small schools which even now have
difficulty in getting probationers. How much more diffi-
culty there will be when other schools, dii'ectly or in-
directly connected with military nursing requirements
are established!
The small hospital is quite as important in its way as
the large, and it has its own serious problems to be solved,
chief of which is the nurse training proposition. Now to
bring together my subject and the situation, as just pre-
sented, in the large and small training schools: — can we
not establish schools for trained attendants connected
with the small general hospitals (fifteen to fifty beds)
which will do much toward solving many of the problems
we have before us? These problems we must meet soon, or
the result of a dearth of nurses will be tragic. First and
foremost, these schools must not be in any way identified
or connected with regular training schools for nurses.
They should be established as schools for trained attend-
ants only, with a certificate — not a diploma — given at the
end of the prescribed course. If the hospital with which
the attendant school is connected is known and adver-
tised as not maintaining a regular training school, the
attendants cannot pretend to be graduate nurses of that
hospital. If we must have practical nurses — and we
surely must — will it not be infinitely better to give them
hospital experience under proper supervision than to allow
the present example of practical nurses to do infinite
harm through the very "experience" they rely upon? I
am sure there are many of us who in our hospital life
have seen sad examples of what the untrained practical
nurse can do, particularly in obstetrics.
It is not necessary for the ti-ained attendant to have
any particular educational standards nor is there any spe-
cial age limit. A grammar school education is usually
sufficient, and the age must be left to the discretion of the
superintendent. This gives a chance for a good and
useful occupation for women who have been denied educa-
tional advantages or who are too young or too old to
enter regular training schools, or who must be entirely
self-supporting during the period of training. The avail-
able material for this work is very large, and it seems
unwise, as well as unfair, to deprive so many of the
privilege of ministering to the sick as we do under present
restrictions. If all the small hospitals would open schools
for trained attendants, think how many of these women
understanding ethics somewhat would be prepared in one
year's time to meet the increased demand for those who
can care for the sick and wounded and supplement the
graduate nurse in her work here and abroad.
Perhaps an outline of the course of a small school for
trained attendants, such as that connected with the Mid-
dletown Hospital, may be of benefit. The course is twelve
months with thorough instruction r.nd practice in all
branches in the practical work of nuising, some theory
relating to this, and an equally complete instruction in
dietetics and invalid cookery. It is interesting to note
that we started this course in October, and in the No-
vember number of the American Journal of Nursing this
subject was treated fully in a letter to the editor, embody-
ing the ideas I already had in mind.
The attendants are at once put into the wards on a
month's probation, and during that time they make beds,
clean and dust wards and rooms, give cleansing baths,
etc. At the end of this period they are put into the
uniform of the school — brown cambric, white bib apron,
cuffs, and collar, but no cap — and for the next two
months they are taught simple treatments such as enemas
douches and watching ether patients. After three
months, they are instructed in taking temperatures,
pulses, and respirations, administering medication — by
mouth and hypodermically — giving temperature baths,
sterilizing dressing instruments, etc. They serve one or
two months on night duty and one month with the dieti-
tian who teaches them to make invalid delicacies and to
prepare trays. They spend one month in the maternity
wing attending deliveries, assisting the graduate nurse,
and giving after-care under direct supervision. One
month is spent with the social service nurse in her out-
door work, and the pupil attendants also serve a short
time in the operating room, learning general operating
room routine, how to handle instruments, etc., although
never taking an active part in operations.
The attendants are required to do all the ordinary
cleaning in the lavatories, wards, and rooms, and the
fact that much of their after success depends on these
homely labors is emphasized. They are thoroughly in-
structed in disinfection, fumigation, and the theory of the
care of contagious diseases, as the hospital does not take
these cases except those usually found in general wards,
such as typhoid or pneumonia.
At the end of the course the attendant receives a cer-
tificate, signed by the hospital authorities, stating that
she has passed satisfactorily this period of instruction
and is qualified as a trained attendant for convalescent
nursing, emergency work and first aid, and has an under-
standing of invalid cookery. This certificate can in no-
wise be mistaken for a diploma, nor can the holder pass
for a graduate nurse by displaying it, for the word
"nurse" is not used, but "trained attendant" is especially
designated, and her work stated to be that of a con-
valescent attendant with qualifications for emergency or
first-aid work.
The wards and floors are in charge of graduate nurses
who closely supervise the work of the attendant, and this
is a fine field for the older nurse whose strength is
limited, but who can do managing rather than the actual
hospital nursing. Those who are unable to serve their
country either at home or abroad, for the reasons above
mentioned, can be an infinite help in this way and so do
their share to relieve present conditions.
For compensation, we give pupil attendants $10 a
month for the first six months and $15 to $20 a month
for the following six months. These prices may be
modified to suit situations and conditions, but we must
pay our attendants a higher salary than we would pupil
nurses, as we are giving them less in theory and practice.
The hospital furnishes board, room, and laundry, and
the privileges of the home are the same as for pupil
nurses.
The salary of the trained attendant, after she has
completed her course and takes outside cases, should be
from $10 to $1.5 a week, until her experience entitles her
to more— $18 or $20. This cannot be strictly regulated,
of course, but doctors and others who would be responsible
in standardizing this approved schedule of prices, hos-
pitals and registries, can be informed of these rates by
the hospital with which the school is connected.
By the demand for practical nurses in Jliddletown,
since I have been here, I am convinced that there is a
large opportunity for women who desire this branch of
the work, and, to me, it is a privilege to train them
properly to meet this demand.
200
THE MODERN HOSPITAL
A Great Vision and Its Realization
To the Editor of The Modern Hospital :
I have just returned from Creston, Iowa, wliere I spent
ten days with Dr. F. E. Sampson in promoting the greater
community association, of which he is the originator.
For thirteen years I have been director of the depart-
ment on tuberculosis of this state, spending much of my
time in lecturing on the prevention and control of this dis-
ease. I have been intimately identified with Dr. Sampson
for the past ten years and am familiar with the greater
community plan. Do not misunderstand me, however, for
to Dr. Sampson belongs the full credit of the development
of the scheme by which rural hospitalization may be as-
sured. He has developed a modern hospital of consid-
erable proportion, with a training school for nurses, stand-
ardized so far as the limits of his field would permit.
It is therefore a great opportunity for me to comment
in a general way on the proposed plan and the hearty
spirit with which it was met in the recent discussion,
which I made throughout the area involved. There are
five counties, Union, Ringgold, Adams, Taylor, and Adair,
with large segments of other counties adjoining, embrac-
ing a population of 101,040 people.
A distinctive feature of the plan is that it makes organ-
ization coextensive with the territory involved and the
hospital the social service center from which is correlated
and sustained an educational program. It does not seek
to develop new local organizations, but to coordinate the
social, religious, moral, educational, economic, and medical
forces.
It affords the opportunity for high standards of med-
ical and surgical efficiency through the provision by the
greater community of facilities for accurate diagnosis,
including scientific laboratory methods, with a highly
trained staff of specialists to cooperate with physicians
and surgeons and the people of the respective communi-
ties. The hospital is not maintained in the interest of
doctors, but for the conservation of health and life.
The relation which the medical profession sustains to
the hospital is one of service, the regulations and require-
ments governing such service to be formulated by the
greater community association itself. It is an attempt to
bring the organized Christian and social spirit of each
community into participation, for the promotion of pre-
ventive medicine. It is proposed to make the hospital the
center, out from which four primary principles will
operate:
1. To employ a social service secretary who will stim-
ulate the instincts in each group to much greater par-
ticipation, with emphasis upon child welfare as the first
consideration.
2. To carry on a permanent educational program on
preventive medicine, reacting upon each community, which
involves country nursing and health supervision of the
children of the various communities.
3. To provide a training school for nurses, second to
none in the United States.
4. To establish a modern hospital in every sense under
the control and supervision of the greater community
association, which will provide for the hospitalization of
all persons in need of such care.
In the interests of this greater community plan the
board of trustees of Cottage Hospital has passed a reso-
lution that as soon as such greater association is formed
and in a position so to do. Cottage Hospital shall be made
a free gift as the home from which this service may be
rendered.
The scarlet thread running through this whole plan is
that it provides for the play of human activities which are
inspired by sympathy for the unfortunate and the poor
without putting the tag of "charity" on the enterprise. It
aims to restore the sufferer to his normal place in the
community by giving him a man's chance.
Any person maintained by a social service commit-
tee, or church, club, public board or individual enters the
hospital and receives such medical or surgical service as
may be necessary, "without money and without price."
All that any social service committee or other agent main-
taining such individual, will have to pay, is such daily
rate at the hospital as is necessary for his board, etc.
The free medical service is compensatory in that it is
the contribution which the physicians make as their share
of the community responsibility. That is, the community
provides the hospital equipment, where the physician may
develop the highest efficiency in serving, and when a pa-
tient receives outside aid, in whole or in part, then the
attending physician or staff of the hospital must render
services of the highest character free.
"Service" is the motto of the greater community asso-
ciation. It is a step forward in socializing medicine. It
is now determined that no one man is big enough to cover
the whole field of medical and surgical procedure without
the assistance and cooperation of others, no matter what
his attainments may be. The conclusion is that if a com-
munity will have service, then it must provide that organ-
ization and equipment necessary to such service.
It is one of the most attractive propositions which I
have ever become interested in. It is a challenge to the
church as a permanent organization looking for the high-
est welfare of humanity. It expresses its beneficent influ-
ence into the field of preventive medicine by the conserva-
tion of health and life and morals of the community. It
would seem that a great prophet has arisen in Iowa.
Aretas E. Kepford,
state Lecturer, Department of Tuberculosis, Des Moines, Iowa.
Mrs. Peggy Ann Sutton and Her Quilt
To the Editor of The Modern Hospital:
At the meeting of the American Medico-Psychological
Association in June at Chicago, I had as an exhibit a
quilt which was made by one of the patients at this hos-
pital, and which attracted a great deal of attention.
One of your representatives there asked me to send a
picture of it to The Modern Hospital. You will find
enclosed a photograph of the patient, Mrs. Margaret Ann
Sutton, aged sixty-four, admitted to this hospital Novem-
ber 1, 1907. She is of the depressed type of manic
depressive insanity. This quilt was made of ravelings
and thread picked up around the hospital. She does it
without any drawing or any sample to go by. To illus-
trate: If any one goes through the hospital she will look
at him and try to work his image on the quilt. She does
it by hand, making one stitch at a time, unaided by any-
THE MODERN HOSPITAL
201
rs. Sutton, aeed 64 years, a ratifnt at the Central Hospital for the Insane. Na-hvill,
nds, one stitch at a time, introducing in it portraits of the people whom she had met.
thing except her eyes and her tact in this line. Standing-
by her is a picture of the quilt that she has worked in
this way. It is a novelty, and those who saw the quilt at
Chicago said they had never seen anything like it before.
The quilt is large enough to cover an ordinary bed.
We are trying to get all patients interested as soon as
their health will permit. We have fifty ladies at work
in the sewing room, tacking carpet rags, weaving carpets,
and making dresses, shirts, etc., for the inmates of the
hospital, and we have recently made 200 new quilts. We
manufacture our quilts in the old-fashioned way, using
quilting frames, and about eight ladies can work on a
quilt at one time. Many of our patients work on the
farm, in the laundry, in the kitchen, help the carpenters —
ir. ''act, we have a six-hundred-acre farm in connection
with the institution, and most of the work is done by
patients.
W. S. Farmer, M.D.,
Superintendent, Central Hospital for Insane, Nashville. Tenn.
202
THE MODERN HOSPITAL
The Nursing Problem: Third-Year Training Under
Government Supervision
To the Editor of The Modern Hospital:
After reading in The Modern Hospital several interest-
ing articles relative to the urgent need of an increased
and efficient nursing force, wherewith to care for the sick
and wounded of our army and navy, the following plan
suggested itself as practically covering the more pressing
needs of the army end navy hospital service, while at
the same time allowing a sufficient margin of supply to
meet all urgent domestic needs.
In the first place, we would suggest that after suitable
examination, senior pupil nurses be granted a certificate
of proficiency — not a diploma — upon which they should be
entitled to apply for admission to the United States Hos-
pital service. Such advanced pupil nurses could render
effective service in the wards, while, at the same time,
they might receive special instruction under the direct
supervision of United States Army and Naval Medical
officials. By this means, immediate and effective relief
could be secured, for, beyond doubt, many advanced pupil
nurses would promptly and enthusiastically volunteer.
In the next place, provision should be made so that after
one year's satisfactory service, each pupil nurse shall
receive a government certificate of approval, which cer-
tificate, coupled with that of the school to which she is
attached, shall assure to her the diploma of the school,
the same as though she had completed the full term of
three years under its immediate supervision and tutelage.
By this means the government would promptly secure
efficient and urgently needed help, and the nurses would
not be retarded in their life work, or in the opportunity
to render early sei'vice in the cause which they hold so
dear. Surely the year of intensive training through
which such nurses would pass must more than equal the
training of the best of our schools during equal time,
and no truly patriotic school board could hesitate to carry
such plan into effect during the period of the war.
Many training schools today find it advantageous to
affiliate with others having special facilities for practical
work in given departments of nursing. By such means,
the general course may be appreciably broadened, and a
more comprehensive education in the art of nursing af-
forded. Again, such a course has the effect of broadening
and elevating the ethical standard, as well as the technical
training of the nurse, and counts for betterment along
all lines.
May we not' hope that some such plan may be adopted
and speedily carried into effect, thus obviating further
delay at this critical time? Relief through the release
of a large corps of sufficiently trained nurses would be
immediately effected, while, in addition, opportunity
would be afforded our schools to accommodate a much
larger number of junior pupils who speedily could be
rendered efficient in the care of the less serious cases
coming into the wards of our home hospitals.
Aug. Korndoerfer, M.D.,
Medical Directoi-. Childi-en's Homeoiiathic Hospital. Philadelphia.
The Institutional Farm, Garden, and Dairy Consultant
To the Editor of The Modern Hospital:
One of the things provided for in the administrative
code bill of Gov. Lowden's was the appointment of a
farm, garden, and dairy consultant for the institution
farms in Illinois. Upon recommendation of the Depart-
ment of Agriculture, I was appointed by Charles H.
Thorne, Director of Public Welfare, to fill this position.
The instructions covering my appointment directed me to
"ascertain the acreage connected with the different insti-
tutions, make a study of the soil conditions at the different
places, make recommendations, and prepare a system of
farm accounting applicable to all."
Shortly after my appointment I issued a call for a
meeting of the head iarmers, gardeners and dairymen to
be held at Springfield on Feb. 14, 1918. They were
instructed to bring with them, to this meeting, a plat of
the different farms, showing the crops they were devoted
to last year. The program included papers on "Maintain-
ing the Fertility of the Soil," by Henry H. Parke, assist-
ant director of agriculture; "A Business Man's View of
the Farm, Garden, and Dairy of an Institution," by
Charles H. Thorne, director of public welfare; and dis-
cussions on dairying, poultry, hogs, alfalfa as an institu-
tion crop, truck gardening, manure pits, corn-planting, etc.
This proved to be a very interesting and instructive
meeting, and I am satisfied that it has been a great
stimulus to increased production and improvement of soil
conditions at all of the institutions, besides providing me
with plats of the different institution farms, and the
ground devoted to different crops last year. From that
information I could form an idea of what the crop outlay
for the present year should be. The total area of the
land owned by the state at the different institutions has
been found to be 11,178 acres, and is divided among the
different institutions as follows: Alton State Hospital,
1,034 acres; Anna State Hospital, 559 acres; Dixon State
Colony, 1,100 acres; Chicago State Hospital, 238 acres;
Soldiers Orphans' Home, 94 acres; Illinois State Reforma-
tory, 276 acres; Elgin State Hospital, 510 acres; School
for the Deaf, 159 acres; School for the Blind, 40 acres;
Illinois State Penitentiary, 2,360 acres; Jacksonville State
Hospital, 343 acres; Kankakee State Hospital, 950 acres;
Lincoln State School and Colony, 528 acres; Peoria State
Hospital, 520 acres; Soldiers' and Sailors' Home, 178
acres; Training School for Girls, 240 acres; St. Charles
School for Boys, 917 acres; Southern Illinois Penitentiary,
524 acres; Watertown State Hospital, 593 acres; Soldiers'
Widows Home, 15 acres.
The land connected with these institutions is made up
of many different kinds of soil, and the climate varies as
much as 11 degrees in mean temperature between the ex-
treme northern and southern institutions.
The general policies I expect to carry out at the
different institutions may be summarized as follows:
1. To maintain and increase the fertility of the differ-
ent farms. This can be done at most of the institutions
by the use of the stable manure, crop rotation, and the
raising of legumes, but at some of the larger farms it
will be necessary to buy lime, phosphate and kainit.
2. To utilize the inmate labor to the largest possible
extent, so that they can be made as nearly self-supporting
as possible. This is not only a source of profit to the
state, but a benefit to the inmates themselves.
3. To adapt the different institutions to the needs of
all; in other words, where the climate and land are
specially adapted to a certain crop, to raise enough at
that institution to supply the needs of some other institu-
tion where that crop cannot be successfully grown. We
expect by following this policy to be able eventually to
raise nearly everything in the farm and garden line used
by the different institutions. Where a surplus of supplies
or equipment is found at any institution, it is transferred
to some other place where it can be used. This saves a
great deal of buying, and also prevents actual waste in a
good many instances. We are also able to introduce new
blood into our hogs, poultry, and cattle in this way with-
out paying fancy prices to outside parties. I venture to
THE MODERN HOSPITAL
208
say that the amount of institution transfers will amount
to fifty thousand dollars by the end of this year. At this
time we have available for transfer twenty tons of alfalfa
hay and eighty tons of mixed hay.
4. To keep at least sufficient hogs at all of the institu-
tions to consume the swill at each place. The records at
one institution indicate a profit of over fifty dollars a
day, and at another of ten thousand dollars a year over
what the swill was formerly being sold for.
5. To build up and ration properly the dairy herds
for greater milk production. To this end I am discourag-
ing the use of prepared feeds, but recommending corn
silage, alfalfa, clover hay, ground corn and oats, bran,
and a small amount of cotton seed or oil meal. To in-
crease the value of the silage, soy beans and cow peas
have been sown with part of the corn at all of the institu-
tions. This not only w-ill increase the amount and value
of the silage, but is also good for the ground.
As an example of what this position will eventually
mean to the state, I am going to cite two instances. On
my first visit to one institution about five or six hogs
were just getting over the cholera. When I asked what
was being done with the swill, I was informed it was
being given away and that hogs could not be raised there
successfully on account of cholera. On my recommenda-
tion one hundred and twenty immune hogs were purchased
for this institution and eight immune sows transferred
there from another institution. On my last visit I found
all these hogs were being maintained on the swill that
was formerly given away, and the net profit was easily
fifty dollars a day. None of these hogs have died,
although this was over three months ago.
.A.t another institution in which the dairy herd was
entered in a cow-testing association, I asked the depart-
ment for the privilege of buying just what was needed
in the way of a dairy ration, with an idea of following
this proceeding at all of the institutions if the result
obtained indicated it would pay. The daily profit on this
herd, as shown by the report of the Jacksonville-White-
hall Cow-testing Association, has been as follows: Janu-
ary, $6.00; February, $9.73; March, $14.00; April, $16.33;
May, $24.29. Average number of cows in milk, thirty-
four. Time of starting rationing, latter part of January.
If the profits can be increased to this extent on thirty-four
cows owned by the state, under this department, it can
readily be seen what it will amount to on the whole
fifteen hundred cows. We expect to follow this arrange-
ment at all of the institutions now.
It is the desire of Governor Lowden that the faim and
garden activities compare favorably with the best of
these industries in private hands, and it is my policy to
try to carry out this desire, and at the same time to
conduct these activities in such a way that they will
be a profit to the state.
Charles T. Hoblit.
Friendly Relations with Patients Established at Admitting
Desk
To the Editor of The Modern Hospital:
Following the publication of an article in the April
number of The Modern Hospital on "The Admitting
System in Use at the Milwaukee Children's Hospital," we
received some inquiries concerning the attitude of patients
toward the rather comprehensive questioning that is
necessary for filling out our registration card. After a
year and a half of this admitting system, we were quite
firmlv convinced that there was no resentment on the
part of patients. However, in order to have a basis in
fact for our reply to these inquiries we made a survey
of all one-visit cases for a month, presuming that in
this group we should find resentment if it existed any-
where.
The survey was begun June 15 and covered all the one-
visit cases for April, 1918, a month during which, owing
to a temporary shortage of workers in the social service
department, no purely medical follow-up work was done.
We found that there were 49 one-visit cases for April.
In 29 of these, return was unnecessary and no return
dates were given. (Eight had been transferred to the
wards or to other medical institutions; 16 had negative
findings or had necessary work completed in one visit;
one came from a family physician for consultation only;
4 were referred to private physicians as ineligible for
dispensary care.) In 3 other cases we knew that the
reason for non-return had no connection with registration
because other children in the same families were being
brought to our clinics.
There remained, therefore, 17 children, the reasons for
whose non-return were in question. A member of the
social service department visited the parents of these
patients. In all but one case, which could not be located,
a thorough investigation was made to get the real reasons
for non-return, /m not otte of these cases was the reason
for non-return in any way suggestive of resentment at the
questioning that was done at the registration desk. The
reasons obtained were as follows:
Well — no need for return 5
Mother working — no one to brinp child 2
Mother confined — no one to brinp child 2
Family moved out of city before date for return (information
obtained from relatives ) 2
Home broken up — child in county institution 2
Child on summer outing — went before date for return to clinic 1
Mother afraid of .x-ray 1
Child afraid of dentist 1
Family quarantined with scarlet fever 1
This study has strengthened our belief not only that
no resentment results from the registration interview but
that a feeling of friendliness between the hospital and
the patient is established at the registration desk.
Harriet Gage,
Director of the Social Ser\-ice Department of the Milwaukee
Children's Hospital.
The Health Officer and the Big Fight
Which health officer should stay at home and who
should go to war? How is the nation bearing up under
the war-strain ? What are the special war-time health
menaces of the civil population, and what are we going
to do about them ? What headway are we making against
the venereal diseases ? These are the questions to be
considered at the convention of United States and Cana-
dian sanitarians at Chicago, October 14-17, to be held
under the auspices of the American Public Health Asso-
ciation. Some of the military sanitarians who will address
the meetings ai-e Surgeon General Gorgas, Colonel Victor
C. Vaughan, and Major William H. Welch of the Army
Medical Corps. Other speakers at the general sessions
will be George H. Vincent, President of the Rockefeller
Foundation; Dr. Charles J. Hastings, President of the
American Public Health Association; Dr. W. A. Evans,
Assistant Surgeon General Allan J. McLaughlin,
U.S.P.H.S., Dr. Ernest S. Bishop, Dr. Lee K. Frankel,
Dr. Frederick L. Hoffman and others.
The final program will appear in the American Journal
of Public Health, appearing September 25. For further
information write to A. W. Hedrich, secretary, American
Public Health Association, 1041 Boylston St., Boston.
204
THE MODERN HOSPITAL
Conducted by ANNIE W. GOODRICH. Principal Army School of Nu
and CAROLYN E. GRAY. Principal City Hospital School o(
Nursing. Blackwell's Island, New York.
Please address items of news and inquiries regarding Department of
Nursing to CAROLYN E. GRAY, Principal City Hospital School of
Nursing, Blackwells Island, New York.
VASSAR'S RESPONSE TO THE NATION'S NEED
FOR NURSES
Serious Motives of Candidates for Nurse Training at
Vassar "Plattsburg" — Evidence of Practical Fore-
sight in Plans for Course
By CAROLYN E. GRAY. R.N., Principal, City Hospital School of
Nursing, Blackwell's Island, New York City
Four hundred and thirty-seven women, graduates of
one hundred and seventeen different colleges, represent-
ing forty-six states and two English colonies, assembled
at Vassar College, pursuing an intensive preparatory
nursing course, constitute the concrete and very practical
form which this response has taken. We have heard
much of the need for nurses. Our government has called
for them in ever-increasing numbers. Many and widely
differing schemes have been proposed in all seriousness
as the only way to staff our civilian hospitals and release
our trained women for government service. In this very
real difficulty the nursing profession has argued that
standards should not be lowered, that the best our nurs-
ing schools have been able to produce were none too good
for our country's need. We have been encouraged by the
whole-hearted support of educators, who appreciate the
many-sidedness of our problems, and whose position prob-
ably enables them to obtain a better perspective than
that of the harassed superintendent of a nursing school
whose own immediate problems are so pressing and
urgent that she "cannot see the forest for the trees."
Nursing is peculiarly a woman's problem, and it is thrill-
ing to think that the idea of the training camp at Vassar
originated in the mind of a woman, Mrs. John Wood
Blodgett. The plan has had the whole-hearted support of
the college trustees and the Vassar faculty, who have
thereby shown how able and ready they are to live up to
the best traditions of Vassar, and that they stand for
such education of women as will fit them for the tasks
and responsibilities awaiting them. The curriculum of
the Vassar Training Camp is no "idle dream." It is the
work of a committee appointed by the National League
of Nursing Education, and represents a three months'
course of intensive study in the sciences, biology,
chemistry, nutrition, etc., that underlie nursing. If the
impressions of an afternoon's visit to several classrooms
count for anything, it is no dilettante undertaking, and
the young women who persevere will have proved their
right to careful consideration by the various nursing
schools which they elect. Some of us have feared that
the nursing motive might not be sufficiently stressed and
that possibly too much emphasis might be placed on the
sciences. These fears were dispelled by a visit to the
classrooms where "practical nursing procedures" are
taught. The large rooms of a gymnasium building,
equipped with the usual hospital furniture, make very
practical and workmanlike wards, and groups of
students were busily employed at bed-making, bathing,
and the usual tasks that fall to the probationer and
junior nurses. The atmosphere of these classrooms was
very earnest and sincere and the interest was quite as
great as in the other laboratories.
Another point of special and practical interest is the
fact that students who have a tendency to "flat-foot" have
corrective exercises prescribed which are practiced under
the direction of a teacher of physical education. This
means so much to the prospective nurse and the school to
which she goes that one feels specially indebted to the
broad-mindedness of those who sought and obtained the
advice of training school superintendents.
Among other evidences of practical foresight is the fact
that the rising hour is identical with the popular (or un-
jjopular) hour in our schools.
"It's ten to six, my room-mate !
Oh, say five-fifty instead !
It gives an earlier impression.
Of what time we get out of bed."
One can anticipate the gratitude with which probation
instructors will welcome groups of pupils who have formed
the habit of rising at 5:. 50 a. m. This early rising hour
gives time for "setting up" exercises which are eon-
ducted, unceremoniously, in the corridors of the various
buildings; the students being allowed to appear in
pajamas, bloomers, etc. That no time is lost is shown
by the fact that breakfast comes at 7 a. m. and the
first classes assemble at 7:50.
The following story suggests that humble duties are
not neglected.
"Wakening in the middle of the night, one of Company
A's in-dust-rious maidens rose from her bed, got her
duster, dampened it in correct style, and began to dust —
when her room-mate wakened her enough to convince her
that inspection seldom or never occurs at 2 a. m. — and the
dust and the maiden settled down once more.'"
Moreover, it was good to see such a wholesome-looking
group of enthusiasts in the probation uniforms of their
respective schools, and the blue, gray, brown, pink, and
stripes never showed to better advantage than on the
campus of Vassar. One interpreted it as an evidence of
closer cooperation between colleges and nursing schools
and earnestly hoped that it was only a beginning from
which much of mutual benefit might develop. The nurs-
ing profession is expecting great things from this group
of picked women, many of whom in addition to their
college training have had valuable years of experience,
for it is encouraging to note that over two hundred have
been teachers. That these women appreciate their
responsibility and opportunity cannot be better told than
by one of their members:
"Three weeks ago, we came, four hundred and thirty-
seven strong, with our eager faces turned toward France.
We thought of Vassar gaily as a 'wait between trains,'
and even regarded our hospital training as an incon-
venient, though necessary, interruption in our progress
toward the western front. Three weeks, so short when
measured against the long months of the Great War —
short even when compared to the one hundred and twelve
^The stories quoted are taken from the Thermometer, published
weekly by the Form Unit and the Nurses in Training at Vassar
College.
THE MODERN HOSPITAL
205
weeks of training which lie before us, but how long in
the vistas of opportunity which they have opened up.'
"Already, we have found, beyond the immediate, press-
ing need of our soldier boys, an infinite human ache which
we are longing to heal. It is not that we care less for
our boys. Each day brings a clearer realization of the
value of their splendid youth and strength, but these three
shoi-t weeks have brought to us the greater vision, the
vision of all who suffer and to whom we may bring relief.
When our blundering, awkward fingers have grown deft
and skillful, we shall find our place. Over here or over
there? It does not matter, and this is the wonderful les-
son which Vassar has taught. In the lecture, in the clas."^-
room, in the very atmosphere of the camp, thei'e has
come to us this message. Service is greater than war,
or peace, greater even than death. It is the very soul of
life. We ai-e talking less of France these days. Most of
us realize that ours may be the sacrifice of 'those who
stay at home,' but because of these wonderful weeks
we are ready to serve either over here or over there."
Some one has said that in this whole scheme, the col-
lege woman is on trial; perhaps she is, but it may be
well to remember that the training schools are also on
trial: and most of all, those who are responsible for the
conditions (whether good or bad), in our schools and
the hospitals which they serve.
THE AMERICAN ASSOCIATION OF HOSPITAL
SOCIAL WORKERS
Purposes of the New Organization — A Directory of Social
Service Departments to Be Ready at Next Meeting
For several years the annual meeting of the National
Conference of Social Work has been the occasion for
the gathering of a group of hospital social workers from
all parts of the country for the discussion of their com-
mon problems and interests. Among the group there has
been a growing idea that they should sometime form a
national organization. This idea found concrete expres-
sion at this year's national conference at Kansas City,
Mo., in the organization of the American Association of
Hospital Social Workers.
The very circumstances which make it difficult to form
a new association this year make it also urgently de-
sirable. The ranks of hospital social workers are much
broken, since many of their most experienced workers
have gone into Red Cross or other war service of one kind
or another. Hospital social workers are facing the neces-
sity of using more volunteer service, of training new
workers, and of meeting new demands with decreased
resources. Therefore, although they can ill spare time
for a new form of activity, they can still less aflFord
to go on without some concerted means of maintaining
the quality of a work assuredly more necessary to the
country's welfare now than ever before.
The purpose of the new association, as stated in its
constitution, is "to serve as an organ of intercommunica-
tion among hospital social workers, to maintain and im-
prove standards of social work in hospitals and dis-
pensaries, and to stimulate its intensive and extensive
development." All individuals and institutions in the
United States and Canada that are doing social work in
hospitals and dispensaries, and those who are "contribut-
ing to the development and execution" of such work are
eligible to membership. Active members are to be those
who are actually doing the work; those who contribute
to its development are to form the associate membership.
The officers are: Miss Edna G. Henry, director of the
social service department of the Robert W. Long Hos-
pital, University of Indiana; vice-presidents. Miss Ida M.
Cannon of the Massachusetts General Hospital, Boston,
and Miss Mary E. Wadley, of Bellevue Hospital, New
York City; secretary. Miss Mary Antoinette Cannon, of
the University Hospital, Philadelphia; treasurer. Miss
Margaret Borgden, of Johns Hopkins Hospital, Baltimore;
executive committee. Miss Marion Prentiss, of Cook
County Hospital, Chicago; Miss Marion Tebbets, of
Elliott Memorial Hospital, University of Minnesota,
Minneapolis; Miss Ethel Riddle, of Barnes Hospital and
Washington University, St. Louis; Miss Harriet Gage, of
the Children's Hospital, Milwaukee; Dr. Louis Morrow,
of the University of California; Miss Mary H. Coombs,
of the New York Conference; Miss Mary Jarrett, of the
Boston Psychopathic Hospital; Miss Margarita Ryther,
of the Protestant Episcopal General Hospital ; and Miss
Grace Bolen, of the Post-Graduate Hospital and the New
York School of Philanthropy; and Mrs. Roberts, of the
Philadelphia General Hospital.
The association is to hold its annual meeting regularly
at the time and place of the National Conference of Social
Work and will also hold meetings with other conferences
of associations with allied interests. The next meeting
will be held at Atlantic City in September, at the time
of the annual meeting of the American Hospital Associa-
tion. The Association of Hospital Social Workers ex-
pects to have a newly compiled directory of social service
departments ready for distribution at that time, and also
some liteiatui'e on various special phases of the work.
The subjects already suggested for consideration by the
association are of wide importance and reach to the foun-
dations of our work. Training for hospital social work
is one such elemental problem. There is at present no
uniform course of training which can be required or
recommended ; hospital social workers have thus far been
made by the most varied combinations of experience.
There are, however, several different courses in operation,
and it should not be impossible to standardize these and
then to require them for workers entering the field.
The definition of the function of hospital social work is
a subject closely allied with that of ti-aining, and one
which must be worked out in connection with other spe-
cialized social agencies, and with the group of hospital
administrators and physicians. With a more exact un-
derstanding of their proper field and use should come
better and more nearly uniform records, statistics, re-
ports, and methods of case-work.
All this and more will be the concern of the association.
It is essential to its success that it have the active sup-
port of those interested in hospital woi-k throughout the
country. Membership application blanks may be had
from Miss Ida M. Cannon, the Massachusetts General
Hospital, Boston, and the association most heartily urges
all concerned to join.
That only which we have within can we see without.
If we meet no gods, it is because we harbor none. If
there is grandeur in you, you will find it in porters and
sweeps. — Emerson.
For everything we leave undone we must sooner or
later pay the bill, and we should take this into account
before we give our orders to Fate. — Ellen Thorneycroft
Fow^'^r.
Never bear more than one kind of trouble at a time.
Some people bear three: all they have had, all they have
now, and all they expect to have. — Edward Everett Hale.
206
THE MODERN HOSPITAL
SOCIAL SERVICE MADE A PART OF NURSES-
TRAINING
Louisville City Hospital Social Service Department Proves
a Success — Scope of Its Work
The social service department of the Louisville City
Hospital, inaugurated with the approval of Mayor George
Weissinger Smith and the Board of Public Safety, on De-
cember 1, under Miss Mary A. Alexander, has already
proved its value to the hospital. The organization of this
department of the hospital activities, the necessary print-
ing of its blanks and forms and the working out of the
details of its operation in connection with the curriculum
of the training school for nurses has necessarily taken
some time, but in spite of this, 101 investigations were
made during December.
The course in social service work has been made a part
of the curriculum of the training school for nurses, each
senior nurse being assigned to this department in turn for
six weeks' training in the field. Shortly the members of
the junior class are to begin work under supervision in
the large out-patient department, where from 150 to 225
patients a day are treated. In addition to the practical
work which the individual nurses assigned to this depart-
ment will obtain, they will, in assembled classes, have
lectures and text-book study on the many aspects of social
service activities.
The work of this department is expected to correlate
the medical and surgical treatment with the social and
economic side of the patients in the hospital and after
they are discharged. Many a surgical patient has been
discharged, greatly improved, into improper and unhy-
gienic home surroundings, and subsequently returned for
a more prolonged stay in the hospital.
The hospital is not a home for convalescents but a
refuge for the sick, and by cutting down hospital days of
patients, beds are made available for the acutely sick,
provided they go into homes where convalescence and
right living can be supervised. This is one of the chief
functions of this department.
An investigation is made of all admissions; a social
diagnosis is made, and no case is dismissed except through
this department. Home conditions have first been investi-
gated before the patient is discharged. Many patients
have been admitted who are not residents of the city and
not entitled to hospital care. These are properly investi-
gated and made either county cases or sent to other in-
stitutions.
The work will be in the closest cooperation with all
other social agencies, and the student workers will study
closely all other institutions in the city, with which this
cooperation will obtain so they may determine whether
they will desire to take post graduate training in social
service work after leaving the school.
The visiting staff member is requested to make specific
recommendations on special blanks regarding social treat-
ment of every patient he discharges, thus obtaining a close
medical and surgical cooperation with the social side.
It is planned to have an advisory committee composed
of a member of the board of safety, the superintendent of
the hospital, the superintendent of the training school, one
or two laymen, and two women specially interested in
social work, with five members of the visiting medical and
surgical staff, repi-esenting the various specialties.
It is believed this new department will soon demon-
strate its value to the hospital and to the correlated char-
itable and social agencies of the city.
The motto of the hospital in all of its departments is
SERVICE.
Conducted by LULU GRAVES.
Please address items of news and inquiries regarding Department of
Dietetics to the editor of this department, in care of The Modern Hos-
pital, Garland Building, Chicago.
The meeting of the American Dietetic Association will
be held in Atlantic City, September 26-8, at the Royal
Palace Hotel, in conjunction with the American Hospital
Association. Sessions of the American Dietetic Associa-
tion will meet Thursday and Friday afternoon and Friday
evening. The general session on Friday evening will
be devoted to the interests of the American Dietetic Asso-
ciation; a business meeting will be held which will be
announced later.
It will be noted that many phases of the work of a
dietitian are being presented. That much benefit is de-
rived from discussions is recognized, and the program
is being arranged with the thought in mind of having
ample time for discussion of each paper. Effort is being
made to avoid crowding so much into the program that
no time will be left for private conferences and for seeing
the exhibits of food products and equipment. We shall
want to hear some of the papers scheduled on other
programs.
There has never before been offered such an oppor-
tunity for the accomplishment of a work which will be of
value to our hospitals as at this meeting of superintend-
ents and dietitians of hospitals and representatives of
commercial products in which we are interested. Though
the expenses of traveling have increased very materially
during the past year, it is to be hoped that this will not
interfere with the attendance at this meeting.
A tentative program is published in this issue of The
Modern Hospital in connection with the program of the
American Hospital Association. We shall have a definite
program ready for mailing early in September.
FOOD CONSERVATION IN AN OHIO HOSPITAL*
How Miami Valley Hospital Hooverizes — Suitable Sub-
stitutes for Wheat, Sugar, and Fat — Some Appetizing
Menus — Close Inspection of Diet Kitchens
Bv SARAH BENEDICT. Dietitia
Valley Hospital, Dayton.
Each household, large or small, has had to meet and
handle in a pioneer way the problem created by Mr.
Hoover's request to conserve, that the Allies and our own
soldiers may have food in order to do their work well.
There has been no precedent for it in our generation.
Many of us have felt that we would be giad to fulfill
government requirements, if conditions were only a bit
different; if there were not so many things to conserve
at once; if only the problem did not loom so large and
Fourth Annual Co
ntion of the Ohio Hospital Asso-
THE MODERN HOSPITAL
207
important when ht'lp was so very scarce, that it would
be far easier in an ordinary liousehold than in an insti-
tution, because there one could be quite sure that the
members of the family would understand and help, while
in a hospital, there are so many people who do not
understand, and who attribute to you hard money-saving:
considerations which are far from true. But the task
with its many and harassing: difficulties still remains,
and if we are to "stand with the colors behind the lines,"
we shall continue to meet the requests of the Kovernment
to the best of our ability. I am not at all vain about
what we have accomplished at the Miami Valley Hospital.
Perhaps many of you brought your dietary scheme to a
more satisfactory basis, both in ways of conforming- to
standards set by Mr. Hoover, and in your ability to give
a moderately full and varied diet to your patients.
We have come some distance, however. Perhaps you
would not have to admit, as I do, that in the days before
the war, ends of loaves of bread, dried slices of bread
and toast accumulated to such an extent that when the
bread-dressing, bread-pudding methods of usage were ex-
hausted a man who kept chickens had to be found to care
for the rest. When the United States entered the war
we ased many methods to break up evil habits — even
dreaming that we could accomplish something by talking
to the maids in the various tray kitchens on the subject,
and to the student nurses in charge. The results were a
commentary on my ability to talk — humiliating in the
extreme.
Our present method does bring results. My assistant
now visits the tray kitchens three times each day — in-
spects bread-boxes, and makes the next delivery of bread
from the kitchen in accordance with the findings. Inci-
dentally, she makes observatio?i of the number of oranges,
lemons, eggs, and amount of broth in each ice-box. An
overstock of all of these has been prevented, thus elimi-
nating the usual waste.
This method, you will say, does not train the nurse, and
I may make reply that, in ordinary times this might not
be the best method, but while the war makes the con-
servation of food a paramount duty, it is the most effective
way of accomplishing the desired result that we thus far
have devised. The average nurse is one of the few-
people very much protected fi-om the exigencies of the
food situation. She neither markets nor is in contact
with those who do; therefore she feels that the request
to put the ends of loaves on the bread and butter plates
of the public patients or not to cut crusts off toast is, to
use her phrase, "carrying this economy racket pretty far."
Of course, our present method of lowering the output
of bread does not entirely do away with the ends of
loaves, the occasional slice cut in excess, or the few slices
of toast prepared against a possible need. We continue
to have enough dry bread to serve dressing with the
occasional veal dinner. At these times we ask that small
servings of bread be given, feeling confident that few
people will care for even an ordinarily large portion of
both. The glorified steam bread pudding, made up with
ground bread crumbs and ordinary cooking figs, is a "joy
forever" in using up left-over wheat bread. Other
steamed puddings, while they seem a bit heavy for a
hospital dietary, do splendid service in providing a
nutritious dessert, with a bread crumb foundation, with
suet for shortening and molasses for sweetening. The
fact that custards and milk puddings of all kinds may be
procured from the diet kitchen for the use of patients not
able to partake of such heavy food makes this dietary
measure a feasible one. We also have croutons in place
of crackers, served with bean soup and cream soups. We
use many bread crumbs in muffin batter, with scalloped
dishes, and as a crust or cover for oven-fried fish. When-
ever we have pie on the menu for servants, we use rice
flour or corn-meal with the wheat flour. At the nurses'
house we conform to requirements in the way of wheat-
less days and wheatless meals. We did have a time to
train our family to live on the prescribed one and one-half
ounce of sugar a day. I am not able to say that we have
absolutely conformed to that iimount, but we have en-
deavored to do so. Our nurses could certainly make use
of more of it, were it permitted them. A recent measure
has been to do away with coffee for the mid-day meal,
and substitute milk. Nurses are, for the most part, great
coffee-drinkers, and ours felt that this change was a real
hardship. The change is better for them, and removes
the temptation to exceed the sugar limit.
We are using an abundance of corn syrup, both in the
nurses' house and in the servants' dining room. We find
the light-colored Karo a pleasant means of sweetening
cocoa. And when a hospital has an abundance of milk,
cocoa is an easy method of adding nutrition to a meatless
supper. An occasional serving of cottage cheese has been
acceptable. Ice-cream made from whole milk and en-
riched with custard made from the yolks of eggs consti-
tutes an inexpensive but nutritious dessert for nearly
every patient in the hospital. The yolks used are the
ones which had been collected from the tray-kitchen ice
boxes, having been left there by the nurses making orange
or lemon albumins. If these are to fulfill their greatest
usefulness, they must be brought to the kitchen every
moi-ning in time for use there, that they may thus be
prevented from becoming stale or dry. When the hos-
liital has many patients newly operated on, the by-prod-
ucts of egg albumins are sufficient to make our custards
and salad dressings, besides being used in ice cream.
While speaking of milk, I might add that we have done
away with buying inferior buttermilk, and make a satis-
factory product from buttermilk tablets and fresh whole
milk.
While we have not had absolutely meatless days for the
hospital patients, the quantity served has been consider-
ably lessened, and for the normal part of the household,
the nurses, the doctors, and the servants, we have con-
tinued to have meatless days, even though they are not
required. The luncheon dishes of cheese, or eggs, or fish
tind a light salad with pie as a dessert (usually the one-
crust kind) and either a cream soup or vegetable soup
as a first course, has been a welcome variation from the
meat and potato type of mid-day meal'.
We have made it a point to use beef very much in
excess of what we would ordinarily use, that the immature
animals might not be sacrificed. By a little concentration
on the subject we found that we can use a number of
supper dishes which would have very little or no meat
in them; a chowder made like turtle soup, but with more
vegetables; baked rice; tomato and meat; spaghetti cooked
in o.xtail broth, and little bits of meat added ; escalloped
tomatoes; corn pudding; scrambled eggs with small bits
of ham; peppers stuffed with rice or bread crumbs niix-
tui-es — all of these are favorites.
In regard to the conservation of fats, we have brought
about no more valuable reform than that of persuading
the chef to trim his meat carefully, making use of every
available pound, and thus preventing the constant dipping
into Ihe lard-can on every occasion. We have lost a
devoted friend by this policy. The fat-and-bone man with
soap interests complains bitterly that there isn't any use
making his horse climb the hill any more.
Butter-cutters which divide one pound into forty-eight
208
THE MODERN HOSPITAL
pieces have been of value in saving this form of fat. In
the tray-kitchens we keep a little earthen-ware bowl,
which is understood to be for our purpose — the collect-
ing of bacon-fat and left-over butter. When this fat is
brought to the kitchen and clarified, by means of careful
heating, with a few slices of raw potato, it makes a most
satisfactory frying medium; and our janitors and order-
lies crave fried food.
In conclusion, I might say that a great deal of waste
may be avoided if the original quantities, sent from the
kitchen, are gauged with some degree of judgment. We
have a small dipper which contains three portions of
stewed or canned fruit or vegetables. The average chef
needs, particularly if he is black, a great deal of observa-
tion, both as to the manner of carving and the quantities
sent out. A frequent visit to the garbage-cans will reveal
much, often, in waste of food, when one thinks all is well.
It often reveals that some part of the house is failing
to separate paper from garbage.
Careful marketing is, of course, a prime requisite in
kitchen economy, and even that has a new phase to it in
these recent months. No longer is it merely a question
of reasonable price (there really "ain't no such thing")
but also of "How much help will I be able to muster to
prepare these vegetables."
SOME OF THE LATEST BOOKS ON DIET AND
NUTRITION
Interesting and Valuable to the Nurse, the Dietitian, and
the Medical Man — Comprehensive Discussion of
Diet in Health and Disease
The attention of the dietitian must soon be given to
class work for the coming year. So many books and
articles are being published on various phases of dietetics,
and with varying degrees of authenticity, that it is a
great satisfaction to have access to a few which are to
be relied upon and which meet our needs.
In hospitals where the work in metabolism is being done
by the combined efforts of the medical men and the
dietitian, the work will be of such a nature that a library
will be most desirable.
If either the medical man or the dietitian is working
without help or cooperation a few good books are indis-
pensable, and the hospital or nurses' training school should
realize this. This department has always advocated the
close cooperation of the dietitian and the medical man,
and the need for this is no less at the present time.
The following books which have come into our hands
will be found valuable in any of these circumstances:
"Nutrition and Clinical Dietetics," by Carter Howe,
and Mason, discusses the dietetic treatment of disease,
covering the theories and facts that have been generally
proved and accepted. Not only the opinions of the authors,
but, in instances in which there is a difference of op'nion
by men of standing, both views are given. The text is
divided into four parts:
Part I treats of digestion, absorption, excretion, and
energy requirement. In the comprehensive treatment of
these topics is included a concise statement on basal
metabolism, and as much as is at present known about
vitamines. The chapters on digestion and absorption are
very good.
Part II is a detailed account of the composition and
ii.utritive value of the common food elements, giving much
information on these points in a conveniently small
amount of space.
Part III is a discussion of feeding in infancy and child-
hood, including breast feeding: feeding normal and ab-
normal children; artificial feeding; feeding the premature
infant; feeding after the first year; feeding during acute
illness and nutritional disturbances.
Pai't IV, which comprises nearly half of the entire
volume, is devoted to the dietetic treatment of disease.
One may well judge of the emphasis laid upon this part of
the volume by the introductory statement: "The intelli-
gent use of food in disease should become more and more
a matter of interest, rot only to the specialist but to the
practitioner as well, and the time is far past when the
conscientious physician can afford to turn over the diet
regulation to the nurse, prompted by the patient's appe-
tite or lack of it." The chapters that follow take up
the adjustment of food to abnormal conditions of the
circulatory organs, the nervous system, and in miscel-
laneous conditions, in addition to those of the digestive
tract and ductless glands which are ordinarily considered.
In reading this book one feels convinced that one is
getting reliable information and scientific facts presented
in a manner which it is a pleasure to read.
Anyone who has been interested in nutrition the past
few years has learned to put absolute dependence upon
the things said and done by Dr. Graham Lusk of Cornell
University. The fact that his "Science of Nutrition" has
reached the third edition is but another proof that this
book has a wide acceptance. It has been revised and
many important facts of more recent findings have been
added. As the name implies, the subject is treated from
the standpoint of the scientist and takes up in detail the
determination of the caloric value of food and the influ-
ence of ingestion of food upon metabolism. It is a valu-
able book in the laboratory because of the specific manner
in which the methods and results of tests ai-e given.
A discussion of the most important and most commonly
known diseases of metabolism will be found in "What to
Eat and Why," by G. Carroll Smith. Not only is the
treatment outlined, but equal emphasis is laid upon n^hy
the prescribed food should be given. Much valuable in-
formation in regard to dietetics is given in a way that
makes it very interesting reading and easily understood,
even by one who has little knowledge of food composition
or food values.
"Modern Dietetics," by Lulu Gi-aves, is a book written
primarily for the dietitian and the nurse. Chapter I is
devoted to the management of the institution dietary de-
partment. The common food elements, their composition,
cooking, and place in the diet, are discussed in the chap-
ters following, up to chapter XII. Special problems in
feeding the various groups of people, diet in disease,
recipes for serving large numbers of people, and tables of
food values are other subjects for discussion. A chapter
is also devoted to the teaching of dietetics to nurses.
Books dealing more specifically with some particular
branch of treatment or some special disease include:
Hill and Eckman's "Starvation (Allen) Treatment of
Diabetes." Details of this treatment of diabetes are given
with typical case histories. Complete diet lists and recipes
are given. So great has been the demand for this com-
plete description of a method of treatment which at-
ti-acted almost universal attention that the third edition
has been issued.
A treatise which covers all the points of the subject
necessary for the average nurse to know is "Infant Feed-
ing," by Clifford G. Grulee. This book does not go into
the details of scientific matter so extensively as does
Morse and Talbot's "Diseases of Nutrition and Infant
Feeding," but it gives enough of the physiology and bacte-
riology of the alimentary canal, the diseases common to
THE MODERN HOSPITAL
209
this tract, and chapters on nutrition, to enable the nurse
to cive intellifrent care to infants and younp children.
The authors of "Diseases of Nutrition and Infant Feed-
ing;," John Lovett Morse and Fritz Talbot, are in the de-
partment of pediatrics at Harvard Jledical School and
are associated with the leadinf!: hospitals of Boston. The
method of infant feeding taught in the Harvard Medical
School is described, including breast feeding and artificial
feeding, with all the principles involved in each. The
chemistry and bacteriological tests of the various forms
of milk and of proprietary foods is given together with
their advantages and disadvantages. The detailed scien-
tific treatment of diseases of nutrition as well as the
digestion and metabolism of food make this a very good
book for one who is specializing in the clinical and prac-
tical side of feeding.
"Feeding the Family," by Mary Swai-tz Rose, is a book
written primarily for the housewife, but which is equally
applicable to those who wish to feed the people in their
care intelligently. The book is not at all technical, and
contains scientific information and facts pertaining to food
materials which form the basis of a good working knowl-
edge of dietaries.
Nulriiion and Clinical Dietetics. By Carter Howe and
Mason. Cloth, pp. 646, $5.50. Lea & Febiger, Philadel-
phia and New York.
The Science of Nutrition. By Graham Lusk. Third edi-
tion, cloth, pp. 641, $4.50. " W. B. Saunders Company,
Philadelphia.
What to Eat and Why. By G. Carroll Smith, M.D., $2.50.
W. B. Saunders Company, Philadelphia.
Modern Dietetics. By Lulu Graves. Cloth, pp. 214, $2. The
Modern Hospital Publishing Company, St. Louis.
Starvation (Allen) Treatment of Diabetes. Bv Hill and
Eckman. Cloth, pp. 134, $1.25. W. M. Leonard, Boston.
Infant Feeding. By Clifford G. Grulee. Second edition.
W. B. Saunders Company, Philadelphia.
Diseases of Nutrition and Infant Feeding. By John
Lovett Morse, A.M., M.D., and Fritz Talbot, A.B., M.D.,
$2.50. Macmillan Company, New York.
Feeding the Family. By Mary Swartz Rose, Ph.D., De-
partment of Nutrition, Teachers' College, Columbia Uni-
versity. $2. Macmillan Company, New York.
News Notes of Dietitians
Miss Lulu Graves severed her connection with Lakeside
Hospital early in the summer in order to have the time
necessary to finish work which had accumulated during
the year and to perfect plans for the meeting of the
American Dietetic .Association. For the past two months
she has been doing this work in the office of The Modern
Hospital in Chicago and at the same time doing some
things in the interest of the department of dietetics. Miss
Bessie Brenton, who was Miss Graves' assistant, is now
head dietitian at Lakeside.
Miss Maude Perry, formerly dietitian at Michael Reese
Hospital, Chicago, sailed early in July for overseas duty
with the Michael Reese Hospital unit. Miss Perry is well
known for her work as a dietitian as well as through
her writings. The little book, "Food for the Sick," which
was put out a year ago, by Doctor Straus and Miss Perry,
has had a wide circulation. Miss Perry's last book,
"Dietetics for Nurses," came from the press shortly be-
fore she sailed.
Miss Louise Stevenson, who was Miss Perry's successor
at Michael Reese early in the spring, has been called by
the Red Cross for service at Camp Custer.
We are always glad to know of any changes made by
hospitals in their dietary departments. The following
young women, who are all college graduates and have had
hospital training as student dietitians, have recently taken
up the work of dietitian in hospitals as indicated:
Miss Gertrude Weber, of University of Illinois, at Olney
Sanitarium, Olney, 111.
Miss Esther Shawaker, of Pratt, at Lewis-Gale Hos-
pital, Roanoke, Va.
Miss Ruth Schreiber, of Iowa State College, at Evans-
ton Hospital, Evanston, 111.
Miss Esther .\ckerson, of Illinois University, at Michael
Reese Hospital, Chicago.
.\gain we urge that any dietitian who is not sure that
her name is on our mailing list send her full name and
address to the editor of this department. It is much to
be desired that some information about your department
and your work also be sent in. This request has been
made in this department before, but we are not in as
close touch with what is being done in many hospitals
as we could wish.
The Lay of the Government Lady
PY E. C.
Anna Maria Sophia Jones
Was just a bundle of skin and bones —
The sort of woman you often meet
With knobbledy fingers and large flat feet —
Her hair was dragged behind in a bunch.
And she had dinner when you have lunch.
The Government Lady came to the door —
With printed leaflets — dozens and more.
She spoke to Maria firmly and long —
And all that Maria did was wrong.
She oughtn't to peel potatoes and boil them.
To peel potatoes was only to spoil them;
She oughtn't to waste the pods of the pea;
She oughtn't to stew and stew her tea;
She oughtn't to feed her baby on bread
Before it had ever a tooth in its head;
(Anna Sophia, mother of five,
Three were dead, but two were alive.
Always had given her baby bread
Before it had ever a tooth in its head);
She oughtn't to spend her money on drink.
She oughtn't to stuff up the drain of the sink;
She oughtn't to shut out air and light;
She oughtn't to close her window at night.
(.Anna Maria Sophia Jones
.Always fastened her window-click,
-Air in a bedroom made her sick);
She oughtn't to buy herself ready-made clothes —
She oughtn't — she oughtn't — Oh, goodness knows.
Before the Government Lady had ended
Anna Sophia was highly off'ended.
-Anna Maria Sophia Jones
Was just a bundle of skin and bones —
The sort of woman you often meet
With knobbledy fingers and large flat feet —
Her hair was dragged behind in a bunch.
And she had dinner when you have lunch.
But Anna Maria had spirit within her —
The spirit that makes a saint of a sinner —
When she saw what was right she went and did it,
And then, if need was, afterward hid it.
-Anna Maria Sophia Jones
Asked in dull and colorless tones
The Government Lady to walk inside,
Opened the door of the passage wide.
Took a chopper and hit her hard.
And buried the body in the yard. — E.xchange.
210
THE MODERN HOSPITAL
INDUSTRIAL
REHABILITATION
OF DISABLED
SOLDIERS AND SAILORS
Conducted by ELIZABETH G. UPHAM.
Director Art Department Milwaukee-Downer CoUeie.
THE PERSONAL ELEMENT AND THE DISABLED
SOLDIER
How Vocational Reeducation Strikes the Man Back From
the Front — Disposing of Fears and Worries — Re-
education Worth All It Costs
In the Vocational Summary, published monthly by the
Federal Board of Vocational Education, Mrs. May H. Pope
tells an interesting little story, which shows the attitude
of the average returned soldier toward his own recon-
struction for civil life again.
The story tells of the plans adopted by the Invalided
Soldiers Commission of Canada as they appear to the
individual soldier and thoroughly illustrates the import-
ance of the personal contact of the men with the voca-
tional officers and teachers and those who have charge of
this work. The returned soldier in this story, an average
Canadian, a carpenter by trade originally, was returned
disabled by a mutilated shoulder which made him unfit for
his former work. He wore the distinguished honor badge
and had been known for conspicuous bravery even among
the fighting Canadians, but was modest about it and con-
sidered himself just like any other returned soldier who
had done his duty and earned the consideration of his
government. The man was suffering, as those of his
kind all suffer, from the shock of war, all the horrors
he had passed through, all the worries about providing
for the care of his wife and two children, and the fear
that his vocational reeducation might deprive him of his
just pension. Following is something of the story he tells
in his own words:
"The journey across the continent had been long, and
the clean hospital beds looked good to me. . . The boys
were doing all sorts of things, weaving baskets, em-
broidering, making cloth on a loom — queer work for sol-
diers, it seemed to me. One man was making a sweater
for his little sister and another said his woi'k helped him
to forget his pains and aches. One day a sensible young
woman came around with raffia in her hand and asked
if I didn't want to make a basket. I refused at first, but
to please her I began the basket. . . Pretty soon I
noticed that my fingers were limbering up considerably.
That basket finished, I wanted to do something more
difficult, and I did."
And again, "I didn't pay much attention to what the
vocational officer said, for I thought the country owed
me a living and I was satisfied with that. I am ashamed
now that I harbored that thought for even a little bit,
but a fellow who is just recovering from the awful strain
of the life over there and not quite over his wounds can't
be blamed too much. I had made up my mind to get some
easy work, but after my talk with the vocational officer
I no longer wanted to be a shirker. He made me see that
thousands of my comrades in France were depending
upon me and others like me for food and other necessities
of life. He made me wish to be a man who counted for
something in the industrial life of the country. We soon
got on friendly terms. I told him all about myself, for
i felt I was talking to someone who cared.
"While waiting ifor my wound to heal, I joined some
classes in the convalescent school and made several articles
that now help to make my home attractive. When it came
to choosing a real trade, I was rather hard-headed about
it and wanted to go into one where my bad shoulder
would have been too big a handicap. I was finally per-
suaded to choose one where my early training would do
the most good ; so I prepared to be a contractor. Then
I began to be afraid that if I held down a job I would
lose my pension and to worry about how my wife and
boys could be cared for; but the officers assured me that
pensions were given on the basis of physical disability and
that an allowance would be sent to my wife each month
while I was in training.
"They gave us good times, too — picture shows, sports,
concerts and dances. The vocational officers are kind, but
firm, too, and a man must stick to his work and not stay
home unless he is really sick. If he does, he loses part
of his pay. A man must make good. There will be plenty
of help after the war, and employers are not to be ex-
pected to employ a returned soldier for charity's sake.
"Do I think the reeducation for the returned man does
any good? Well, I guess I do. If it did nothing but show
a fellow that there are some men in the world like the
district vocational officer and the teacher, I would cast
my vote for it. Nothing means more to a man who is
'down and out' than to feel that somebody understands.
It puts heart into a fellow to be taught to help himself
when he has lived for days with the dread that he might
always be a burden to his family, and the knowledge that
his country still counts on him to do his share makes him
buck up as nothing else can. The men who are teaching
these boys to live cheerfully in spite of their broken
bodies are great. Yes, sir, it's worth all that reeducation
has cost, just to show the returned man how to face life
again."
THE INTER-ALLIED CONFERENCE ON AFTER-
CARE OF DISABLED MEN
Healing of the Mind as Much a Part of Rehabilitation as
Healing of the Body — Galsworthy's Foreword
The second annual meeting of the Inter-Ailied Confer-
ence on the After-Care of Disabled Men was held in
London, May 20-25, 1918. Delegates were sent to London
from Belgium, France, Italy, Poi-tugal, Serbia, Siam,
United States, Canada, Australia, South Africa, New
Zealand, India and Newfoundland.
The conference represented those most distinguished
and experienced in reeducation in these countries. The
purpose of the conferences has been stated by John Gals-
worthy, who has written the foreword to the published
reports.
"The conference in Paris last year, and this conference
in London, were summoned that the countries who stand
shoulder to shoulder in the fight may stand shoulder to
shoulder also in the task of remedy, profiting by each
other's success, avoiding each other's failures; that the
whole field of recovery may be surveyed ; the holy purpose
of this crusade of healing be fortified in the hearts of all
who serve; and a sign made manifest to the peoples of
each country that the debt due is remembered. To lift up
the man who has been stricken on the battlefield, restore
him to the utmost of health and agility, give him an ade-
quate pension, and reequip him with an occupation suited
to the forces left him — that is the process which does not
cease till the sufferer fronts the future keen, hopeful and
secure. And such restoration is at least as much a matter
of spirit as of body. Consider what it means to fall sud-
denly out of full vigor into the dark certainty that you
can never have full strength again, though you live on
twenty, forty, sixty years. Though you have the soul of
a hero, the flag of your courage may well be down half-
mast."
The splendid idealism and the earnest purpose which
inspired these workers and which pervaded the confer-
ence have been voiced by John Galsworthy in the following
extracts from his Foreword:
THE MODERN HOSPITAL
211
"The Angel of Peace, watching the slow folding back
of this darkness, will look on an earth of cripples. The
field of the world is strewn with half-living men. That
loveliness which is the creation of the esthetic human
spirit — that flowering of directed energy which we know
as civilization; that manifold and mutual service which
we call progress — all stand mutilated and faltering.
"In every township and village of our countries stricken
heroes of the war will dwell for the next half-century.
The figure of Youth must go one-footed, one-armed, blind
of an eye, lesioned and stunned, in the home where it once
danced. The half of a generation can never step again
into the sunlight of full health and the priceless freedom
of unharmed limbs.
"P" ranee! The country of the long romance! Who can
see France and not love her — the land with the mysterious
smile, with the clear thoughts and the gay, unconquerable,
self-seeing spirit? France, the eternal type of Mother-
country — she surely will not fail her sons who serve and
suffer. Italy, whom the gods love, and chose, I think, for
the land where Beauty should be embalmed for ever, so
that man might look on it age after age and drink of
inspiration — she will not forget to fill again the lives of
her wounded children with hopes and usefulness. And the
Little Country, trodden and ravished — none in the world
had quite her teeming energy — she will be last of all to
let the stricken go down their days drained of strength
and interest.
''America, too, I know, new as yet to this conflict and
the wreckage thereof. Of this great, warm-hearted nation
I prophesy deeds of restoration, most eager, most com-
plete of all."
Of the disabled man, Galsworthy says:
"He shall yet live as happy and as useful — if not as
active — a life as he ever lived before. Do your worst;
you shall not crush him! We shall tend him from clear-
ing station to his last hospital better than wounded
soldier has ever yet been tended. In special hospitals,
orthopedic, paraplegic, phthisic, neurasthenic, we shall
give him back functional ability, solidity of nerve or lung.
The flesh torn away, the lost sight, the broken ear-drum,
the destroyed nerve, it is true we cannot give back; but
we shall so re-create and fortify the rest of him that he
shall leave the hospital ready for a new career. Then we
shall teach him how to tread the road of it, so that he
fits again into the national life, becomes once more a
workman with pride in his work, a stake in the country,
and the consciousness that, handicapped though he be, he
runs the race level with his fellows, and is by that so much
the better man than they.
"It seems, to one who has watched, rather from outside,
that restoration worthy of that word will only come if
the minds of all engaged in the sac-ed work are always
fixed on this central truth: 'Body and spirit are inextrica-
bly conjoined; to heal the one without the other is im-
possible.' If a man's mind, courage and interest be en-
listed in the cause of his own salvation, healing goes on
apace, the suff'erer is remade. If not, no mere surgical
wonders, no careful nursing, will avail to make a man of
him again. Iherefore I would say: 'From the moment he
enters the hospital, look after his mind and his will; give
them food; nourish them in subtle ways, increase that
nourishment as his strength increases. Give him interest
in his future; light a star for him to fix his eyes on. So
that, when he steps out of hospital, you shall not have to
begin to train one who for months, perhaps years, has
been living, mindless and will-less, the life of a half-dead
creature.'
"That it needs special qualities and special effort quite
other than the average range of hospital devotion, is
obvious. But it saves time in the end, and without it
success is more than doubtful. The crucial period is the
time spent in hospital; use that period to re-create not
only body, but mind and will-power, and all shall come
out right; neglect to use it thus, and the heart of many a
sufferer and many a would-be healer, will break from
sheer discouragement.
"Of the men and women who have this work in hand
I have seen enough — in France and in my own country,
at least — to know their worth, and the selfless idealism
which animates them. Their devotion, courage, tenacity,
and technical ability are beyond question or praise. I
would only fear that in the hard struggle they experience
to carry each day's work to its end, to perfect their own
particular jobs, all so important and so difficult, vision of
the whole fabric they are helping to raise must often be
obscured. And I would venture to say: 'Only by looking
upon each separate disabled soldier as the complete fabric
can you possibly keep that vision before your eyes. Only
by revivifying in each separate disabled soldier the will
to live, can you save him from the fate of merely con-
tinuing to exist.' "
CARRY ON
A Magazine Devoted to the Reconstruction of Disabled
Soldiers and Sailors
The office of the Surgeon General in Washington edits a
little magazine called Carry On, which is devoted to re-
construction. It is published for the Surgeon General by
the American Red Cross and was planned to give propa-
ganda and education, not only to those interested in the
work of reconstruction, but also, through them, to the
general public, to prepare the public mind to regard the
problems of the reconstruction of the disabled soldier in
a sane and practical way and to prove to his family that
he is not merely an object of sentiment and charity but
a part of a great economic problem and an industrial
factor in the country's welfare.
The editorial board includes Col. Frank Billings, M.C.,
N.A., director of the Division of Physical Reconstruction,
Office of the Surgeon General, U. S. Army; Lt.-Col. Casey
A. Wood, M.C., N.A., Office of the Surgeon General, U. S.
Army, and Capt. Arthur H. Samuels, S.C, N.A., Office
of the Surgeon General. The advisory board bears the
names of ex-Presidents Roosevelt and Taft, Surgeons
General Braisted and Blue, and many other well known
men.
Some of the contributors to the August number include
Mr. Roosevelt, Charles M. Schwab, director general of
the Emergency Fleet Corporation, Judge Julian W. Mack,
Augustus Thomas and John Galsworthy. It is needless
to say that writers of international reputation are giving
their writings to help in the reconstruction work.
The circulation of Carry On must necessarily be limited
to those interested in the development of reconstruction
work. Many thousands of requests have reached the Sur-
geon General and have been listed. Men and women who
would like to receive this magazine and have not yet had
an opportunity to subscribe, may do so by forwarding a
request, and Carry On will be sent without charge for
one year. Send name, address, and occupation to Carry
On, Office of the Surgeon General, U. S. Army, 311
Fourth Avenue, New York City.
My dear Robert: — One passage in your Letter a little
displeased me ... . You say that "this world to
you seems drained of all its sweets!" At first I had
hoped you only meant to insinuate the high price of
Sugar! but I am afraid you meant more. O Robert, I
don't know what you call sweet. Honey and the honey-
comb, roses and violets, are yet in the earth. The sun and
moon yet reign in the Heaven, and the lesser lights keep
up their pretty twinklings. Meats and drinks, sweet
sights and sweet smells, a country walk, spring and au-
tumn, follies and repentance, quarrels and reconcilements,
have all a sweetness by turns. So good humor and good
nature, friends at home that love you, and friends abroad
th."^ miss you — you possess all these things, and more
innumerable; and these are all sweet things. You may
extract honey from everything; do not go a-gathei-ing
after gall I assure you I find this world a
very pretty place. . — Charles Lamb to Robert Lloyd.
212
THE MODERN HOSPITAL
THE WAR:
ITS HOSPITAL, MEDICAL
AND NURSING ASPECTS
A V. A. D. IN A FRENCH HOSPITAL
Desperate Need for Nursing Care for the Wounded in Mil-
itary Hospitals Over There — Letters of an
English Volunteer
INTRODUCTION.
These extracts from a little volume entitled, "Letters
from a French Hospital," are here republished by kind
permission of Messrs. Houghton Mifflin & Co., because
they give such a vivid picture of the need existing in the
military hospitals on the other side. While these letters
were written three years ago, the letter from the com-
mander of an American base hospital in France, pub-
lished in our editorial columns (August, page 115), indi-
cates that the need for additional nursing care is not over.
The fact that our own American boys may, by this time,
be in need of the ministrations described makes these
letters of renewed timely interest. — Editors.
Extracts from "Letters from a French Hospital"
Hopital Temporaire, Somewhere in France, 31 July, 1915.
Of course, what I am doing is against my conviction. I
think only fully trained nurses should help the wounded.
But the fact remains that most fully trained nurses can-
not afford to work for nothing, and support themselves,
and unless V. A. D. people will come, the poor wounded
are left to the orderlies. And I am, or any other out-
sider is, better than that. And oh, the poor, poor fel-
lows lying in dirt and discomfort! I shall not write often
while I am here because I can already see such piles of
things that want doing. And there are not enough band-
ages, not enough dressings, not enough sheets and towels,
not enough disinfectants, not enough anything. Thank
goodness, I got accustomed to a certain amount of mak-
ing shift at the Cliniea. It was really a better training
than an English hospital with everything tip-top. And
Dr. said I could feel assured that I knew
enough to be a valuable help, and every batch of wounded
will make me know more. Anyway, animo v adelante. . .
4 September, 1915.
. . . They are all so charming to me. As the wards
are so big, it really is very little that I can do for each,
and they make so much of it. They are not used to
much care, and the little I give them is repaid a hundred-
fold by their gratitude. Not one ever disputes a word
I say; sometimes the orderlies fetch me because so-and-so
won't do what he is told, and I wonder whatever I shall
do if he does not listen to me, but I only have to appear
and all is well. The other day I was fetched because a
man operated on that morning would get up. He was a
great big Breton, and I should have been nowhere if he
chose to resist. When I got near, someone said, Tiens,
voilaMlle. Mees! Poor Fevre looked round and said,
J'etais en tram de me remettre, and got back as meek as
a lamb. As soon as they are up and convalescent, they
try to help me with the cleaning, etc. . . .
22 October. 1915.
Your nice letter .iust to hand. I love hearing from you
and being assured that the Zepps have not got you.
As to my breaking down, no; nobody need worry. I
think I can stand it all ri?-ht, accidents apart, of course.
And so long as I can hold on. I feel I ought. It is not
to praise myself that I say it. but we are no longer al-
lowed to have trained paid nurses here, and of the par-
tially trained, I am the best. Partly because I have had
an exceptional chance with my doctor friends in Spain,
and partly because I have a funny kind of brain that goes
for essentials. The result is that my major takes the
worst cases for my division and then does not look at
them for days together. I keep a slate hung up, on which
I mark the number of the bed where there is a wound I
mistrust, or some change that I do not understand, and
those are the only cases he looks at. I am thankful to
say that all my wounds are clearing up at last, and the
men doing well — all except one who has typhoid, and I
have him in a room apart. Things are made unnecessarily
hard for us here. There is a typhoid ward, and it would
have lightened my labors to send my man there, but by
the time typhoid symptoms appeared, they had filled up
the said ward with the lice-covered clothes, so I had to
keep him, and most of the time I am too busy to do every-
thing myself, and must trust to the obedience of an ignor-
ant orderly to do the rest. Also, instead of our men's
clothes being changed before they came to their ward, they
were sent up as they were, and we were not allowed to
take the clothes out of the ward until each man's posses-
sions had been niimerottes. It took the corporal two days
to do my division, and by that time my nice clean wards,
cleaned under inci-edibly difficult circumstances, were, and
are still, crawling. I am not exaggerating; I spend my
life trying to oust them — hateful, disgusting! I wear an
antivermin belt myself, and finding that they got on to
my feet and ankles, I cut up a belt and wrapped pieces
round my ankles and knees under my stockings. That
settled them. If ever they get past my ankles, they per-
ish in the second trenches at my knees. Of course, it
spoils the appearance of my ankles, and in a hospital
where all the administration is masculine, it requires some
courage to know that one looks like a very fat woman
whose calves have slipped. Since I wrote you last, we
have had no fresh wounded, consequently life is easier.
Yesterday I got off at 4 p. m. and had a walk — the first
in three weeks, Sundays not excepted. Consequently, to-
day I am once more full of beans. In other ways also
things are better now, some fresh ladies came out and
I have been allowed two, one who had already served two
months in another division, and one quite new. For that
I thank the major, as I think he had a fight for it. One
lady helps me in the salle de pansements, and the other
does ward work, so there is a hope of once more being
straight and clean. Even now we are only twelve to this
huge hospital ; I know several who would and could come
and help, but a military hospital is hedged in by red-tape
entanglements, and until a new order comes, we are not
allowed more. However, our medecin-chef is convinced of
the need for more, so perhaps he may succeed in getting
permission soon. Until then animo y adelante. . . .
12 December, 1915.
... I am so looking foi-ward to Christmas Day; we
told our wards we should have a tea and they are pleased!
In my division some of the not-so-ill are going to sing,
and some are learning up things out of the comic papers
to recite. And they have no inkling of the little pres-
ents in store for them; that will be quite a surprise. I
shall do up each gift in paper with the name on it be-
cause they love to be known to us by name. In the hos-
pital they are numbered according to their beds, and I
find it easier to remember them by their wounds, especial-
ly as my major never knows them by anything else; they
are celid de repaule fracturee, rampiite de la jambe,
I'osteite du tibia, etc.. but once I was told that they spoke
with approval of me because to me each man was un etre
et pas nn miinero, so now I learn each name as he comes
in, and I am usually just getting the name thoroughly
connected with the wound and the face when the man is
considered well enough to move on to a convalescent
hospital. . . .
We enjoyed your hospital stories. This is the best I
had heard before:
"A Highlander was dying in a hospital ward somewhere
in France, and he begged and begged to be allowed to
hear his native music once more. So a piper was brought,
and the Highlander was so greatly cheered that he took
a turn for the better and recovered. But all the rest of
the ward died."
29 December, 1915.
. . . Today I am rather sad and lonely; two of my
anciens have been discharged ; they were here already
when I came, and were hitherto never quite well enough
THE MODERN HOSPITAL
213
to be evacuated. Since they have been up and about they
have waited on me hand and foot, and were always dis-
covering some new thing they could take off my hands.
Also they were such nice fellows, and one especially was
full of esprit. He is an infantry corporal, and in peace
time was chief cashier in one of the large champagne
houses. He has one month's leave and then back to the
trenches; and my major, who likes him immensely, says
it is murder, because there is one spot in his right lung
which has never properly healed. The major says he
will never get over the wound quite, and a wet night or
two will be enough to kill him. Yesterday he was called
rather hastily to the conaeil de convalescence, and when
he got back, he lay down on his bed and I could hear his
breathing all down the ward. Ten minutes later he was
back in the salle de pansements to cut dressings for me.
Today the cracucs left at 7 a. m., but when I went on
duty, I found everything ready for mc, instruments ster-
ilized, hot water on the boil, disinfectants all prepared,
etc., and the blesses told me the corporal had been get-
ting things ready since before si.\. Vou will realize how-
hardened I am getting when I tell you that I got through
the day's work without poisoning every wound with my
tears. . . .
5 February, 191G.
. . . My division has been evacuated until I have only
twenty-nine men. I had intended to take it easy a little
as soon as I had got the beds disinfected. The medecin-
chef leaves it to me to arrange the work as I think best
and take any time off that I like, so I had looked forward
to an afternoon or two off. As luck would have it, a tele-
gram has just come, telling us to prepare for two hundred
and four wounded. They are expected at 3 a.m. That
means that we tumble up by 2:30 and put cocoa on the
stove and hot water ready to clean the men. Then they
probably won't arrive till 5 or 6; meanwhile we hang
round and shiver and have whispered convei^sations with
any poor dear who may be awake. This sounds like a
grumble, but really I am happy, as much so as I could
be while the world is full of hatred and suffering. You
know a woman cannot be really unhappy while she is
adored by never less than twenty-five men at a time! I
never thought there could be such gratitude in_the world
as I get for my small services. The other day I had a
man amputated nearly up at the thigh. Of course, he
might easily have a hemorrhage after that; so in the
night I stole down the ward to raise the clothes and see
whether there was any leakage. I went very quietly to
awaken no one. But the beds are very near together, to
accommodate as many as possible, and as I turned away,
satisfied, I was suddenly seized by the man in the next
bed: 'Mademoiselle, chere petite mademoiselle, vous pen-
sez a nous quand vous devez vous reposer. Que les Ang-
laises sont gentilles, jamais je ne les oublierai!' and I
crept away with my heart warm and my hands a mass
of kisses. You see. Uncle, I could not be better paid,
and it even gives me pleasure to be known everywhere as
la petite mademoiselle.
Must go to sleep. I hope you do not mind my letters
being untidy. I write them in bed so as to rest all I can.
THE ANGEL OF MERCY OF THE UNITED STATES
NAVY*
The Distinction Between the Hospital Ship, the Ambulance
Ship and the Transport — Arrangement and Equip-
ment of the Hospital Ship "Mercy"
There is some confusion in the minds of people ashore,
says N. J. Blackwood, commanding officer and medical
director, U. S. Navy, writing in a recent number of the
American Joitrnal of Surgery, as to the distinction be-
tween hospital ships, ambulance ships and transports for
the wounded. These terms are easily understandable, if
one will liken the hospital ship to the hospital, the
ambulance ship to the ambulance which brings the
patients to the hospital, and the transport for wounded
to the train or other conveyance that might be used to
carry large numbers of sick and wounded from place to
here presented by
place. The hospital ship is merely a floating hospital —
a vessel equipped with everything that pertains to hos-
pital use for the care of the sick and injured, whose
duty is to attend the fleet at its base and care for all
cases of illness and injury originating in the fleet, who,
with a fair degree of certainty, may be able to return
soon to their respective duties on their respective ships.
It is not a part of the function of the hospital ship
to transport sick and wounded from the fleet to a base
hospital ashore, or to transport sick and wounded across
the ocean. Its equipment is far too elaborate for any
such purpose, and the spaces allotted for the different
departments are too small for the accommodation of large
numbers of such casualties.
The hospital ship should remain at the fleet base to
repair the personnel of the fleet and return it to its
duty, and, unless it should become overcrowded by an
e.xcessive number of patients, it should remain at that
fleet base or move from one fleet base to another when the
fleet itself changes its base. It should never, under any
circumstances, be separated from the fleet or its main
base, but always should be at hand.
It should not be required to take care of any very
large numbfer of contagious cases, because these cases may
be numerous but mild, and the hospital ship would soon
become overcrowded with these cases. Every fleet should
have, in addition to a hospital ship and an ambulance
ship, a contagious disease hospital ship.
The ambulance ship, the analogue of the ambulance
attached to a hospital, should be a ship of moderate size,
capable of carrying from 100 to 150 cases, and so arranged
as to be able to segregate the various kinds of contagious
diseases, and also the medical, surgical and other cases
that it might carry from the fleet to the base hospital
ashore. This ambulance should should make periodical
trips from the fleet and transfer the cases of illness and
injury which are apparently destined to a long con-
valescence or whose convalescence will be more rapid
ashore, and also to relieve any congestion on board the
hospital ship itself. The equipment of the ambulance
ship is simple, its principal needs being a small operating
room and large dressing rom for renewing dressings and
performing minor surgery, with large spaces for ambulant
cases and a sufficient number of bunks to accommodate
the more seriously ill. Its galley accommodations should
be of the emergency type, but capable of quickly furnish-
ing special diets and meals for the total number of
patients that it can carry. The trips made by the
ambulance ship would, in all probability, be short,
occupying not more than five or ten hours, and the
patients, therefore, would require attention and care only
during that period. A fairly large staff of nurses might
be necessary but the medical and surgical staff could be
comparatively small.
The transport for carrying sick and wounded long dis-
tances is altogether a different proposition from the hos-
pital ship and occupies a position midway between the
hospital ship and the ambulance ship requiring less equip-
ment than the hospital ship and yet more than the
ambulance ship. .\ny large transport could be easily
fitted for this purpose, requiring merely in addition to
its equipment for ordinary transport purposes, operating
and dressing rooms of sufficient capacity, and a large
enough corps of nurses and medical staff to take care of
the patients for a period of two or three weeks. Major
operations would be performed only in an emergency, and
the duties of the personnel would be to renew dressings
and care for the ordinary every-day necessities of con-
valescent and convalescing patients.
214
THE MODERN HOSPITAL
Before the present war began, the United States pos-
sessed but one hospital ship, the "Solace," which was a
converted merchantman and had been in service as a
hospital ship about nine years. Since war was declared,
the navy has added two more hospital ships to its fleet,
the "Mercy" and the "Comfort," two ex-Ward liners. As
Fig. 1. The hospital ship "Mercy."
the "Mercy" and the "Comfort" are sister ships, the de-
scription of one will serve for both.
The "Mercy" is a ship of about 10,000 tons displace-
ment and is fitted with every modern appliance for the
care and treatment of the sick and injured. The con-
version of a merchant ship into a hospital ship is a very
difficult proposition, and the ideal hospital ship will
never appear until it is built from the keel up. Such a
ship has been appropriated for by Congress and has been
started, but the necessity for ships of other character
has delayed its completion. In converting the "Mercy"
into a hospital ship, the endeavor has been made to place
the wards for the more seriously sick — the operating
rooms, laboratories, etc. — on the upper decks where natu-
ral light and ventilation can be utilized to the full, and to
locate below on the lower decks such wards and rooms
as would accommodate the convalescing, the ambulant
cases, and the departments which are not so dependent
upon natural light and ventilation. We therefore find on
the upper or promenade deck, from forward aft, first
the operating suite, then the sick officers' ward and
convalescent officers' rooms, and abaft these, the isolation
wards for contagious diseases. On the deck just below, or
hurricane deck, are placed the surgical ward immediately
below the operating suite and connected to it by an eleva-
tor, the dental office, dressing room, diet kitchen, dis-
pensary, x-ray room, laboratory, medical ward, and their
accompanying appurtenances. Both these decks are above
the hull and therefore have through-and-through ventila-
tion and large windows for natural light.
On the main deck are the prophylactic room, the
x-ray developing and study room, the eye, ear, nose and
throat operating room and ward, and the genito-urinary
and large convalescent ward.
The rest of the ship is taken up with quarters for the
crew and the hospital corps, and storerooms and ma-
chinery which are necessary for the upkeep of the hos-
pital as well as of the ship.
The operating suite, the contents of which were donated
by the Colonial Dames of America, consists of operating
room, sterilizing room, instrument room, anesthetizing
room, scrub-up room, and pus operating room. The gen-
eral operating room is a model in equipment. The only
difference between tliis operating room and those ashore
is the fact that everything must be secured to the deck
in its proper place, and is, therefore, not ordinarily mov-
able. The room also has a portable pantostat machine
for cautery work of all kinds. A certain amount of
natural light comes in through the large ports on all
sides, but a fine set of electric lights is furnished over
each of the operating tables and also at different places
throughout the operating room.
The rooms in the operating suite are tiled, sheathed,
and painted with white enamel paint.
The surgical ward, just below the operating room, has
space for fifty-four bunks arranged in two tiers, with a
possible expansion capacity to nearly double that number.
The bunks are of the tubular iron type with wire woven
springs, and many of them are fitted with the Goetz ad-
justable springs for placing patients in the Fowler
position.
Four operating teams could work simultaneously, which
means that the capacity for efficient surgical work is
enormous and probably exceeds anything but the gravest
emergency. In order to promote efficiency and coopera-
tion, the head of the surgical department has also general
supervision over the roentgenology, genito-urinary, and
the eye, ear, nose and throat departments, while a close
association is maintained with the medical department,
thus giving all patients the benefit of the knowledge and
abilities of the various specialists in these departments.
The ward for sick officers contains eight beds and six
rooms, the former for the more serious cases requiring
Fig. 2. Transferring a patient.
constant attention of the nurses, and the rooms for the
less seriously ill and convalescent cases. This ward, like
all the others, is fitted with every convenience that
ingenuity and thoughtfulness could dictate. A large and
comfortable mess room is provided for the convalescent
officers, and a dumb waiter connects this mess room with
the neighborhood of the galley and special diet kitchen on
the deck below. The linen room for the general distribu-
tion of linen on this deck is situated just abaft these
quarters and in this room all of the repairing and dis-
tribution of the linen takes place. From this point to the
after end of the ship are the contagious disease wards,
five in number, with a total capacity of forty-two bunks
and the possibility of expansion to at least three or four
times that number for temporary accommodation.
On the after end of this deck is found an enclosed
space for a solarium, which will be utilized for the over-
THE MODERN HOSPITAL
215
flow of contagious cases, and, when no contagious
cases are being housed, for the recreation of convalescent
patients from all of the other wards. This solarium hos-
pital treatment will enable the patients to live practically
in the open air and sunlight and at the same time to be
protected from all bad weather conditions.
Just abaft the surgical ward, on the starboard side,
are the administration offices and the pay office, and next
to them the office of the dental surgeon.
On the port side, opposite the offices just described and
abaft the surgical dressing room, is the diet kitchen, con-
taining electric range, pasteurizing machine, steam cooker,
coffee urns, and sink, and capable of providing special
diets for all the wards. Just abaft the diet kitchen is the
x-ray room, equipped as completely and perfectly as ex-
perience and careful selection could devise. The founda-
tion of the installation is the current generator or trans-
former, which is of the most modern type and of greatest
capacity of 12 kilowatts. This has been especially altered
so as to adapt it to use aboard ship by the addition of a
number of features not required under ordinary hospital
conditions ashore.
Just abaft the x-ray room is the laboratory, with good,
natural light and ventilation, and equipment of the latest
imp'-oved type, well adapted for all requii-ed chemical and
pathological examinations, including urine examination,
chemical and microscopical; complete chemical and
microscopical examinations with bacteria determinations
by inoculations or cultures; stool examinations, chemical
and microscopical ; all ordinary tests with special refer-
ence to determination of intestinal parasites, amebas or
determination of type; preparation and standardization
of autogenous vaccines; pathological diagnosis of tissues.
In connection with this laboratory is an extensive animal
house on the boat deck containing compartments for
guinea-pigs, rabbits, sheep and fowl, all of which are
provided and cared for under the best conditions possible.
Fig. 3. Corner of operating room.
pathogenic bacteria; gastric analysis, chemical and
microscopical, and detection of common poisons; sputum
examinations, chemical and microscopical, with refei'ence
to detection of pathogenic bacteria and their isolation;
throat swab smear examinations and cultures; blood ex-
aminations, including the determination of blood urea and
blood sugar; complete mici'oscopical examination for
determination of blood cell changes or detection of blood
parasites; blood cultures for detection of presence of
pathogenic bacteria; serological examinations; complete
fixation reaction of lues; tuberculosis, and chronic
Neisserian infections; agglutination reaction with spe-
cial reference to determination of immunity; examinations
of body fluids, transudates and exudates; bacteriological
and cytological diagnosis; spinal fluid examination com-
plete; determination of carriers, typhoid, diphtheria,
meningitis and virulent pneumonia, micro-organisms with
Fig. 4. The surgical ward.
This brings us to the portion of the ship where the
medical officers live, and just abaft this is the medical
ward. This strictly medical ward contains thirty-six beds
and is for the use of the active and purely medical bed
patients. The light and ventilation are natural,
supplemented by artificial light. Everything that is
ordinarily found in the medical ward of a hospital is
present here. The accommodations of this ward can
easily be expanded, and it is flanked on either side by a
good, wide, open deck on which convalescent patients
may lounge in long chairs and get the benefit of open air
and sunshine. Abaft the medical is the autopsy room,
this being so placed with regard to the patients as to
remove all objectionable suggestion of possible unfor-
tunate termination to those who are still in a precarious
condition.
The eye, ear, nose and throat ward is situated forward
on the main deck just below the surgical ward, and, like
all other wards, is fitted with the necessary appurtenances
for the proper care of the sick. The operating and ex-
amining room for this department is completely equipped
in every respect and is much more fully supplied than
the average specialist's office ashore. All minor opera-
tions, as well as special treatments, will be done in this
office while under normal conditions and in an emergency,
should the general operating room be not available, major
operations could be performed in this room.
At the after end of this deck and immediately under
the medical ward is situated the large genito-urinary and
convalescent ward, which contains 136 bunks arranged in
two tiers and is capable of expansion to probably 200.
In the after end of this ward is a separate room for
venereal treatments.
This comprises the chief features of the hospital de-
partments proper, but there are many accessories which
are essential to the support of the hospital as well as
the upkeep and care of the ship itself. Of all these
accessories, there is none that can compare for usefulness
and advancement in equipment of modern hospital ships
with the "mechanical cow," a machine which has been
but lately put on the market and bids fair to solve the
problem of milk supply for the sick on hospital ships when
216
THE MODERN HOSPITAL
at sea or removed from a base where good milk can be
obtained. The milk produced by this machine is made
from a combination of unsalted butter and skimmed milk
powder, and can be produced with any degree of butter
fat required. Cream that will whip is also a product of
this machine, and it all tastes like the very best dairy
milk and cream that one can get anywhere, and really
Fig. 5. The solarium.
is so. By means of this machine, 15 gallons of cold,
pasteurized milk can be produced in 45 minutes, and if
more is required the operation is simply repeated, whereas
if an excess amount is produced, it has only to be placed
in the milk cans and put in the cold storage room where
it will keep indefinitely just as fresh dairy milk will do.
An ice-cream machine, run by electricity and controlled
by one man, for making ice cream in large quantities,
will make ten gallons at a time, and is for use when large
quantities of ice cream are desired, but is supplemented
by simple quart and pint freezers for individual diets for
the sick.
The cold storage plant is large enough to carry fresh
provisions for from three to six months, so that the hos-
pital ship is absolutely independent of outside' aid for
that period at least. In connection with the cold storage
plant is a refrigerating machine which will produce, un-
der favorable circumstances, a ton of ice a day, besides
furnishing the refrigeration for the cold storage,
"mechanical cow," mortuary, and the refrigerating rooms
where meats, eggs, milk, and other fresh provisions are
kept for daily issue up to the amount of one week's
supply.
The distilling plant, consisting of evaporators and dis-
tillers, is sufficient to furnish 35 gallons of fresh water
a day per capita for 600 people, which will insure plenty
of fresh water for the sick and crew for all necessary
l)urposes. Two large disinfectors of the American
Sterilizer type are built in at the after end of the con-
tagious wards and are capable of disinfecting large num-
bers of mattresses, bedding, and even furniture, which
may come from the contagious wards.
A mortuary, where bodies may be placed in cold storage
after having been properly embalmed and put in
Fig. 7. Mechanical
ilk separator.
metal caskets, is presided over by a registered under-
taker and embalmer and, it is hoped, is far too large ever
to be filled, though it has been constructed with a view
to the excessive number of dead under war conditions.
The galley or kitchen and commissary department is
under the direct management and control of the pay-
master of the ship and is fully capable of providing foods
of any kind, except the special diets, for at least six hun-
dred people, containing as it does, all the modern
appliances of ranges, steam cookers, electric ovens, coffee
urns and bakery, of modern and most approved type.
In the after end of the ship, on the main deck, is
situated the laundry, which is equipped with all the best
and most modern type of electric laundry machinery, in-
cluding washers, tumblers, extractors, pressers, mangles,
ironers, shapers, dry room, and all the accessories found
in the well-known steam and electric laundries.
There are, besides the accessories already mentioned,
many others, such as the carpenter shop, machine shop,
electric shop, storerooms for dry provisions, medical and
surgical supplies and dozens of other things which readily
occur to all those familiar with requirements of hos-
THE MODERN HOSPITAL
217
pitals. All necessary means of amusement have been
provided for convalescents.
The povernment has supplied a good fiction library,
which has been supplemented by contributions from
various sources. A liberal supply of games for the amuse-
ment of those who are confined to their bunks, and are
not able to get about the ship, has been furnished by
patriotic persons. Provision has been made for all of
the American athletic games, such as baseball, swimming,
boxing, etc., and all hands are encouraged in perfecting
themselves in rowing, sailing and swimming.
The spiritual welfare of all hands is looked after by the
chaplain, who, in addition to the religious duties which
belong to his profession ashore, has charge of all the
amusements and entertainments.
* * * *
RED CROSS CONVALESCENT HOUSE AT WALTER
REED HOSPITAL
Soldiers and Sailors Thrive in "Homey" Atmosphere —
Accommodations for Mothers — Forty-Three Other
Houses Stationed at Convenient Posts— Recrea-
tion and Informal Surroundings
This convalescent house at the great Walter Reed Army
Hospital in Washington is one of forty-four such homes
which the "greatest mother in the world" has built or is
Fig. 1. Front
Eeeii Hospital, WashinKtcn. U. C.
building to help her sick soldier and sailor sons — men
returned from France or newly drafted privates — back to
health and happy usefulness. In connection with every
hospital at all the great camps in America, the American
Red Cross is providing one of these "stations on the road
back to strength." And the "gi-eatest mother" has a place
also in her home for other mothers. She has provided
on upper floors twelve comfortable bedrooms which are
for the accommodation of mothers or i-elatives summoned
to the hospital, who thus are enabled to spend their entire
time within call of the bedside.
To the men who are convalescent, the American Red
Cross says "Drop over home. Don't bother to dress.
Only the home folks. Come as you are." "Come as you
are" to a man just allowed to get out of bed and wild
CO get away from the smell of iodoform and scenes of sick-
ness, means bathrobe and slippers. And these are full
dress, day or evening, in these clubs which seek to restore
strength through comfort, rest, sunlight, air and plenty
of wholesome recreation.
A few steps from the wards or a few pushes on the
wheel of a rolling chair from all the big hospitals bring
convalescents into this lively place where no one has
time or opportunity to talk about his troubles. If the
surgeon has suggested a sun bath, a big solarium or sun
porch invites him to lounge in comfortable chairs or on
mattress swings. The broad screened-in porch provides
the fresh-air cure in pleasant company and with all sorts
of games available on easily moved tables. Here, too, the
Fig. 2. In the
parlor, Red Cr
alescent House.
smokers gather to discuss the war news and "go over the
top" with the newspaper strategists.
The main lounge which opens into the solarium ordi-
narily is a large homelike parlor and reading room fur-
nished with wicker and lounging chairs, big divans,
tables, book shelves, writing desks and special recrea-
tional equipment, including two phonographs and a player
piano. It is on occasion used as an amusement hall for
presenting shows, concerts, and movies.
Just off the main lounge is the mail room, library filled
with specially chosen books and periodicals, the informa-
tion desk, and the supply department. A kitchen and
pantry is just beyond it, ready to handle the mess for the
Red Cross staff, if necessary, or to serve as a special diet
kitchen, in preparing unusual dishes for convalescents.
The Red Cross will give the lower floor of one of the
two wings over to the Y. M. C. A. for use as a billiard
and pool room and as headquarters for "Triangle" activi-
ties which apply to the sick.
The furnishings of the Red Cross rooms are provided
by the local Red Cross chapters. Many individuals and
organizations contributed, and several of the guest rooms
were furnished as memorials. The diversional equipment
Its activities.
provided by the Red Cross was assembled under the direc-
tion of Miss Jane A. Delano, head of the department of
nursing. Men and women Red Cross workers, specially
218
THE MODERN HOSPITAL
selected for ability to assist convalescents will be on duty
day and evening to do everything possible to make the
men comfortable.
These convalescent houses also will serve as head-
quarters of the Red Cross Communication Service and
Camp Service in each locality. Throug'h these services,
the men at camps and hospitals can keep in touch with
their families, and relatives and friends can get constant
news of patients' progress. Soldiers worried about the
condition of their families can, through the Department
of Civilian Relief, put into instant operation Red Cross
agencies charged with seeing that the dependents of a
soldier do not lack for any essential that it is possible
for the American people to provide.
These houses are being provided in connection with army
hospitals at the request of the Surgeon General. They will
be built also at all important naval hospitals. For the erec-
tion of the fifty or sixty which may be needed, the Red
Cross has set aside $512,000. In addition to that at
Walter Reed Hospital, houses are now open at Camp
Upton, L. I.; Camp Devens, Mass.; General Hospital No. 1,
New York, and Camp Dix, N. J. Similar convalescent
houses are being rushed to completion at the following-
thirty-nine camps and hospitals: Camp Meade, Md.; Camp
Gordon and Camp Hancock, Ga. ; Camp Jackson, S. C. ;
Camp Logan and Camp Bowie, Texas; Camp Wadsworth
iind Camp Sevier, S. C; Camp Custer, Mich.; Camp
Stuart, Newport News, Va.; 5th Naval District, Norfolk,
Va. ; Ft. Oglethorpe, Ga. ; Camp Taylor, Ky. ; Camp Sher-
man, Ohio; Camp Wheeler, Ga.; Camp Travis, Texas; 1st
Naval District, Chelsea, Mass.; General Hospital No. 3,
Rahway, N. J.; Camp Merritt, N. J.; Great Lakes, I'l.;
Camp Shelby, Miss.; Hoffman Island, N. Y.; Camp Dodge,
Iowa; Ft. Sam Houston, Texas; Camp Cody, N. M.; Camp
Grant, 111.; Camp Funston, Kansas; Camp McArthur,
Texas; Camp Pike, Ark.; Camp Beauregard, La.; U. S.
General Hospital No. 19, S. I.; Mineola, L. I.; Camp Fre-
mont, Cal.; Camp Harry J. Jones; Camp Kearney, Cal.;
Camp Lee, Va. ; Ft. Des Moines, Iowa ; Pelham Bay, New-
York; Fort McPherson, Ga.
Large Portable Sterilizing Machine for Pershing's Troops
in France
The largest piece of sterilizing apparatus ever con-
structed will soon be sent to General Pershing's forces in
France. The illustration shows one of the sterilizing
steam boiler which provides the necessary high-pressure
steam. The portability of these machines permits their
use very close to the fighting lines.
By the use of these ste-rilizers it is possible to take
men out of the trenches and send them to one of the
many stations where facilities are provided for bathing
and cleansing of their bodies while the clothing and
effects of the men can be thoroughly disinfected in less
than forty minutes in one disinfector. Surgical dressings
can also be sterilized. (Censored and passed by the Com-
mittee on Public Information.)
One of the Tent Wards Provided by the Brooklyn Navy
Yard Hospital for the Care of Sick Sailors.
The tents are erected over a raised wooden platform
which permits the circulation of air underneath, keeping
Copyright Underwood & Under-wood, New York.
them cool, dry, and clean. Each tent is equipped -with
hospital cots, chairs, bedside stands, and wire cage lock-
ers for two patients.
HOSPITAL TRAINS FOR AMERICANS IN FRANCE
Copyright Underwood & Underwood, New York
machines devised by Dr. Leon L. Watters to minimize
the danger of disease among our soldiers. Each appara-
tus is complete in itself, weighs 8,000 pounds, and has a
Equipment of Trains — All Modern Medical and Surgical
Facilities Provided — Patients Supplied
With Every Comfort
The hospital trains for transporting American soldiers
wounded in France embody the improvements that have
been worked out by the French and British since the first
hospital train was built. Our cars are firmly built, at-
tractive, and, on the whole, resemble a "coast-to-coast"
American "limited." Owing to the distance between the
battlefront and the United States, necessarily these trains
must be supplied by England and France, largely under
the direction of the British railway executive committee.
The plans for building have been standardized, and build-
ing operations are proceeding rapidly.
Maj. Howard Clarke, in a recent issue of the Medical
Times, describes a standard train with sixteen coaches,
including: one infectious car, 18 beds; one staff car, 8
beds; one kitchen and sitting sick officers' car, 3 beds and
20 seats; eight ordinary lying ward cars, 288 beds; one
pharmacy car; one' infectious case sitting car, 56 seats, 14
upper berths; one kitchen and mess car, 3 beds (for
cooks); one personnel car, 30 beds; one train crew and
store car; total, 400 beds. The average empty weight of
the train, without engine, is about 450 tons, and the aver-
age length of the train, without engine, 920 feet. Each
"moving hospital" is equipped with conveniences — electric
lights, steam heat, electric fans, laboratories, lavatories,
THE MODERN HOSPITAL
219
Views of ambulance train; tl) stores
(2) car for infectious bed cases; (3 and 4) kitchen; (5) ward
rhis illustration is shown here by courtesy of the Medical Times^
(6) pharmacy and dispensary car.
racks for personal belongings, and even smoke trays for
the patients' indulgence.
The cases are classified, and the badly wounded, the
slightly wounded, the infectious cases and the mental
cases are separated for transpoi-tation.
Eight ordinary ward cars for patients have each thirty-
six beds, arranged in tiers of three. These can easily be
converted into seats to accommodate patients who are able
to sit up, used for stretchers in emergency cases, or folded
against the sides of couch when car requires cleaning.
The pharmacy car is placed midway in the series of
eight ward coaches, in order that surgical and medical
supplies can easily be accessible. This car also contains
'ntgs and linen. In one section is a small room with a
collapsible table for dressings and minor operations.
In the kitchen is a heating tank that keeps 50 gallons
of hot water ready for use. Another tank furnishes water
to drink, making about 2,500 gallons on each train.
220
THE MODERN HOSPITAL
HOSPITAL HOUSEKEEPING AND WAR-TIME
ECONOMIES*
Compactly Built Hospitals Desirable — How One Hospital
Keeps Down Its Bills — Getting the Most Out of Help
— A Plan for Keeping a Hospital Clean — How to
Make Inspection Tours Profitable
By C. L. BUTTERFIELD, Superintendent, Martins Ferry Hospital,
Martins Ferry, Ohio.
The hospital which is compactly built is a better propo-
sition to handle than the one which covers more floor
space for the same number of patients. As an example
of this point, I have jotted down a few figures from the
expense item of a lifty-bed hospital which last year gave
12,099 days' service to patients. The coal bill was less
than $400. Of coui-se, we have the advantage of being
fairly on top of the coal fields, and so do not have to pay
freight and other incidentals.
A second item which interests me is the expense of our
laundry service. Since December we have not been able
to hire a laundress, so we have sent all our work out to a
laundry in the town at a cost of about $250 a month. I
have consoled myself with the idea that we are spending
no more than when we tried to do part of it ourselves.
Even if I am convinced later that my idea is wrong, we
shall keep right on, as we do not expect to be able to hire
laundresses until the war is over.
For two reasons our pay-roll is brief:
1. Our plant is simple, with no complex machinery to
handle.
2. We cannot get the help.
We house the housekeeper, cook, kitchen helper,
waitress, and janitor, who is our general utility man.
In this way we are reasonably sure that our morning
work will start off on time. These persons are very im-
portant, and we regard them as part of the general
family, thus increasing their feeling of interest in the
institution. Our housekeeper has been with us eight
years, our cook four years, at least, and we are now
putting her younger sister in the dining room as waitress.
We plan to have two or three scrubwomen all the time,
more or less. This moi'ning it is less, so we hired two
young boys to come in for the summer, or at least for a
few days, to do some of this class of work. Our scrub-
women who come every morning at 7:30, have two meals
served to them; they leave at 3:30, and are paid $30 a
month.
We have raised the wages twice this year and find the
help just as migratory as before.
No one needs to lack for work in this community at
present. Unskilled labor receives $3 a day, while steel
workers are paid $10 to $20 and $30 a day. In all the
mills women are filling the places made by the draft
•Read at the Fourth Annual Convention of the Ohio Hospital Abso-
boai-ds. The only thing that relieves our situation is the
drunken husband. If it were not for this form of parasite
I do not know where we would find any of this class of
helpers, and so we profit by their misfortunes.
Our main stand-by in cleaning up is plain soap and
water. We are in such a sooty neighborhood, there is
nothing for us to do but wash and scour and repaint when
necessary. I am sure we all agree that washing is
superior to the ordinary fumigation, and is considerably
less expensive. Our floors are covered with linoleum,
which we wash and polish with a liquid wax; this keeps
them a good color and preserves them also.
We constantly repair, paint, and improve in every way
possible. During the last year we have installed as many
labor-saving devices as we could afford which met our
needs. In fact, if I should name them all, you would
wonder how we managed before without some of them.
However, with the aid of these appliances we are able to
meet the strain of increasing work handled by fewer
employees.
Our last purchase was a motor lawn-mower which is
the most wonderful help of all, as we have two acres of
lawn which, theoretically, could be cut by hand in a
week, but which really was never finished. Now the man
can do the work in three afternoons easily. We have
also changed our type of flower garden, planting shrub-
bery and hardy perennials instead of annuals, thus lessen-
ing the amount of time necessary for their care.
In regard to inspection and supervision, we assign the
general hospital and nurses' home to the housekeeper,
while the dietitian is responsible for the kitchens and
store rooms where thi foodstuffs are kept. Often, if there
is time, I take a student nurse with me to view the nurses'
home, giving her a list of suggestions to be carried out,
and the next visit always shows an improvement of
former conditions.
The best way to check up on yourself is to escort visitors
around the institution personally. In this way you surely
see all your own shortcomings in the way of manage-
ment, and at the same time your inspection does not ap-
pear so personal to the heads of the various departments.
I have given you only a plain tale from the hills — •
simply taking the ))roblem of the physical care of a hos-
pital not from the ideal standpoint toward which we wei'e
all aiming a few years ago, but from the situation of
today — cutting our garment from our cloth.
What access have your hospital employees to the food
supplies? "Many a mickle makes a muckle," and an
orange or lemon or pear occasionally doesn't matter much,
but every one of these items "swiped" piles up, and even-
tually the sum total is measurable. An employee going
about eating an orange is an outright invitation to others
to locate the source and help themselves.
How much labor are you getting out of your common
help? Has each person a definite allotted task? Is that
task made out in a practical way and is it based on ex-
perience and observation? Or is it based on the house-
keeper's or head janitor's favoritism?
The real joy of leisure is known only to the people who
have contracted the habit of work without becoming en
slaved to the vice of overwork. — Henry Van Dyke.
Remember: Pains are symptoms of life; dead ones
never have them. — A. W. Burgess in Journal of Outdoor
Life.
THE MODERN HOSPITAL
221
The Duties of Interns and Superintendents of Nurses
To the Editor of The Modern Hospital:
Kindly give us your best ideas regarding the duties of
interns and the superintendent of nurses.
We are trying to have the best of everj-thing and would
appreciate an early reply.
A Sisterhood Hospital.
We know of no one who is better qualified to define
the duties of interns than Dr. J. M. Baldy, president of
the Board of Medical Education and Licensure of Pennsyl-
vania, whose two articles entitled, respectively, "The
Standards of Hospital Education for Interns" and "Has
Every Hospital the Inherent Right to an Intern?" ap-
peared in our June and August issues.
The duties of the superintendent of nurses must vary,
of course, with the size of the hospital. Formerly, before
nursing education had reached the place of standard it
now occupies, and before the superintendent of nurses
was considered as an officer of the hospital, the woman
occupying this position was a general utility nurse and
filled in wherever she was needed, in the operating room,
in the planning and supervising of diet, in the housekeep-
ing and office work, and even on floor duty when the
emergency arose. In consequence, this woman, who
should have had her time free for the proper supervision
of the theoretical and practical training of her nurses,
was used as a nurse instead of an executive.
This has always been one of the causes of the neglect
of nursing education in smaller hospitals. In many in-
stances, even where the hospitals had grown beyond the
use of a superintendent of nurses, doctors and superin-
tendents still clung to the old traditions that the superin-
tendent of nurses must be personally present in many
places where the work could very well be done by pupil
nurses. The executive work really required by the head
of the training school had to be neglected, in consequence.
A superintendent of a training school is one of the
officers of the hospital and entitled to sit at the council
table in any questions of importance which involve the
nursing care given in the institution. She should, of
course, have her own office, well equipped with proper
files to care for the records of the nursing care of
patients and the nurses' education. In a hospital of more
than seventy-five beds she should have one of the
graduates employed as her assistant. She should have
proper living quarters, a suite, if possible, with bath.
The duties of a superintendent of nurses consist of her
supervision 'of the training school and of the nursing care
of the patients in the hospital. This means that all mat-
ters pertaining to this nursing care which is given to
patients by her student nurses and supervising nurses
must be her responsibility. All graduate supervising
nurses should report to her and be subject to her orders.
All requisitions for supplies connected with the nursing
care of patients should come through her office and re-
ceive an O. K. there before being filled. All matters of
complaint on the care of patients and discipline of the
nurses should be referred to her. The time of all nurses
should be arranged in her office, as well as all matters per-
taining to the nursing education of the training school.
The superintendent of nurses is the executive head of the
training school and the hospital officer who is responsible
for the nursing care of the patients, the education of the
nurses, and their physical and social welfare.
We appreciate the privilege of assisting such a hospital
as oiir correspondent in obtaining "the best of every-
thing." The desire to do so furnishes further evidence of
the progressive spirit evinced by many of the hospitals
controlled by sisterhoods.
Written Versus Oral Instructions for the Hospital Staff
To the Editor of The Modern Hospital :
A copy of the rules and regulations of our hospital
is being sent to you. They were revised last year. We
have always felt it advisable that the printed rules and
regulations be limited as much as possible, and that they
be comprehensive, but not go too much into detail. With
the resident system in vogue, we depend upon the older
rnembers of the staff to instruct the incoming men in hos-
pital precedent and routine. In fact, we depend upon
the residents to exercise a certain amount of supervision
over the conduct of the members of their staffs. We hive
always felt that this plan has worked out pretty well,
but with the increasing size of the staff, although at
present it is reduced, and with present conditions — that is,
having fewer men on the senior staff — the question has
arisen whether we ought not to consider formulating a
set of rules which enter more into detail for the guidance
of the staff. I should like to know what your experience
has been and what is your opinion in regard to having
a set of rules which cover the details of hospital procedure
for the conduct of men on the different services.
Superintendent of a Teaching Hospital.
The question that you raised about the relative de-
sirability of printed rules representing either a mere
skeleton of the practice of the hospital or a very complete,
comprehensive, and detailed description of its methods
of internal procedure is one of considerable interest from
an administrative standpoint.
With you we lean toward elasticity in hospital adminis-
tration, believing that the word-of-mouth method of giv-
ing instructions is the best method in a small institution
where there is constant and intimate contact between the
executive and his subordinates and where in the regular
course of events a very large proportion of the daily
routine of the hospital comes under the immediate per-
sonal notice of the executive.
When, however, an institution begins to be a sizable
affair, when the administrative work is necessarily split
up into many departments, each with a more or less
independent and autonomous executive officer, when the
mass of administrative detail becomes so great that much
of the work of supervision must necessarily be deputed to
assistants and subordinates of various grades, it becomes
desirable to put into written form and thus to make
accessible to every member of the staff and to all the
workers of the hospital the wishes of the administration
concerning the manner in which all procedures, even the
most minute procedures where these concern more than
one group of employees, should be carried out.
In such a hospital the superintendent scarcely has the
time, for example, to meet with new members of the house
staff regularly enough or often enough to come to a
thorough understanding with them concerning what the
hospital desires of them in their official capacities. Hence,
it may be found desirable to issue for the house staff
a little pamphlet containing extracts from the rules and
regulations applicable to this special group.
222
THE MODERN HOSPITAL
ALBERT ALLEMANN. M. D.. Foreign Lii
Army Medical Museum and Library. Office of the Sur&eon-Gc
United States Army.
The Red Triangle Tuberculosis Farm Colony. Brit. Jour.
Tuberc, London, 118, XII, No. 1.
The National Council of Young Men's Christian Asso-
ciations has purchased thirty acres of land at Kinson, in
Dorset, where it has established a farm colony for tuber-
culous soldiers. Only patients in the early stages of the
disease are accepted. The men live in wooden chalets
distributed over a sheltered and wooded portion of the
estate. Each chalet is divided into two sections, each
containing two beds. The central building contains dining
and recreation rooms, kitchen, and offices. The work is
graduated. It consists of cultivating vegetables and fruit,
keeping bees, rearing of poultry and pigs, etc. More
extensive farming operations, however, will be under-
taken later. The colonists receive one shilling each work-
ing day. The aim of the institution is not only to cure the
patients but to give them a training which will enable
them practically to begin life again.
The Woman's Hospital in the State of New York.
Founded in 1855. An Historical Sketch. J. R. Goffe,
Am. Jour. Obstet., N. Y., 1918, LXXVII, No. 4.
This institution is the first woman's hospital ever estab-
lished. It owes its existence to Marion Sims, the father
of gynecology, and one of the greatest figures in the
history of .American medicine. Dr. Sims moved from
Alabama to New York in 1853. There, by the aid of a
number of wealthy ladies, he secured a private building
where he opened in 1855 the first woman's hospital. It
was a success from the start. In 1867 a new building
was erected which was enlarged in 1877. Then in 1902
the hospital buildings were sold and a more suitable place
selected. The new hospital was opened December 5, 1906.
It has been greatly enlarged and not only is it the first
woman's hospital in the world, but it stands today in the
front ranks of the institutions of its kind. Many other
brilliant names besides that of Sims — Emmet, Thomas,
Peasley, Noeggerath, and Welsh — are also connected with
the history of this hospital.
The Hospitalization of Patients with Pulmonary Tubercu-
losis in the Federal Capital. E. R. Coni. Semana med.,
Buenos Aires, 1918, XXV, No. 8.
The population of the city of Buenos Aires has groviTi
so rapidly that 1 ospital acommodation has become a press-
ing question. There are no special tuberculosis hospitals.
Patients with pulmonary tuberculosis are housed in the
Muniz Hospital, an institution devoted to all kinds of con-
tagious diseases. The building contains 932 beds. The
greater number of patients placed there are affected with
pulmonary tuberculosis, but in addition to these, the hos-
pital has care of 76 lepers, 58 trachoma patients, 12
syphilitics, besides patients with typhoid, diphtheria,
measles, etc. In 1902 the city passed a law that no
patients with pulmonary tuberculosis should he received in
the general hospitals. But this law could not be carried
out because there was no provision made for the hos-
pitalization of the numerous tuberculous patients. The
author proposes to devote the Muiiiz Hospital entirely to
patients with pulmonary tuberculosis and to erect a new
hospital for the other contagious diseases.
A Children's Pavilion at the Sharon Sanatorium. V. Y.
Bowditch. Boston ]\Ied. & Surg. Jour., 1918, CLXXVIII,
No. 16.
The Sharon Sanatorium at Sharon, Mass., an institution
devoted to the care and treatment of tuberculous women,
is about to enlarge its work by adding a children's
pavilion. This annex is intended to be a combined sana-
torium and school for debilitated children with suspected
tuberculosis and for those who are in the earliest stages
of pulmonary or glandular tuberculosis. Only patients
of refinement, with moderate incomes, will be received.
The charge will be ten dollars a week exclusive of laundry.
The Mayo Clinics at Rochester, Minn., U. S. A. A. Tange,
Ziekenhuis, Amsterdam, 1918, IX, No. 4.
The author, a surgeon of the Dutch navy, visited the
famous Mayo Clinic at Rochester. He describes this great
establishment in detail and sums up his observations
with the concluding remark that "within the limits of
attainable perfection the Mayo Clinics form a work of art,
science, and social service more complete and farther
developed than any institution modern medical science
has thus far produced." The article is accompanied by
numerous photoprints and ground-plans of the various
buildings.
The Course of Instruction for the Wounded of the Biffi
Pavilion. E. Medea. Osped. Maggiore, Milan, 1918,
No. 3.
The instruction comprised a complete elementary course
taught in the primary schools of Italy. A number of
prominent ladies of the Red Cross gave their time to this
work with rare devotion. The school was a great success.
The men, many of whom could not read or write, mastered
the entire course within a comparatively short time, and
the final examination was held with most gratifying re-
sults. In answer to those who might fear lest the hos-
pital be turned into a school, the author observes that
since many of the sufferers, owing to the nature of their
wounds, have to stay a considerable length of time at the
hospital, these days may well be employed to pi'epare the
patients for a useful future life.
The Operation Barrack of the Board of Surgical Ambu-
lances of the Army. Riv. di ingegneria san., Turin,
1918, XIV, No. 3.
This operation barrack was designed for the Italian
army by order of the Ministry of War. It is a dismount-
able barrack of wood, 7 meters (nearly 23 feet) square
and covered by heavy tent cloth. A partition divides it
into two rooms of 7 by 3.5 meters each. One of these
is the operation room proper. Its three outer walls are
almost entirely formed of windows. The other room
serves for the reception of the wounded. It contains a
small dark-room for an x-ray apparatus. The floor is of
wood covered with linoleum. The barrack is electrically
lighted, and three coal oil stoves furnish the heat. The
THE MODERN HOSPITAL
223
operation room contains two opcratin"; tables. The bar-
rack is so constructed that each half can be mounted
separately if the nature of the ground requires it. It is
expected that this barrack will solve the difficult prob-
lem of rapidly supplying any part of the front with the
necessary surgical facilities if the occasion demands it.
The New Lying-in Hospital in Arezzo. L. Pagliani.
Riv. di ingegner. san., Turin, 1918, XIV, No. 4.
As in many European cities, the hospitals of Arezzo
are of antiquated construction and do not come up to the
standard of modern hygiene. The city has now decided
to construct a great new general hospital on the pavilion
plan. The obstetrical pavilion has already been com-
pleted. It is a fine, substantial three-story structure
built of white stone, located on the top of the hillside on
which the other pavilions of the future hospital are to
be erected, and faces south-east. The first floor contains
rooms for the nurses, the kitchen, store-rooms, etc. On
the second floor the left wing is taken up by the obstet-
rical section and the right by the gjTiecological depart-
ment. The third floor is entirely devoted to the care of
babies. A special division is set apart for the illegiti-
mate children.
Sanatoriums for the Tuberculous in the West of the United
States. J. B. Pons. Eco cientifico, Ciego de Avila,
Cuba, 1918, I, No. 5.
The author visited a number of sanatoriums in the
Western States. In Denver he paid a visit to the splendid
Home for the Tuberculous of the Episcopal Church. This
building is situated 6,250 feet above the sea and overlooks
the flourishing city of Denver. The Glockner Sanatorium
at Colorado Springs is 6,000 feet above the sea and can
house 40 patients. The Colorado Sanatorium at Boulder
lies at an altitude of 5,300 feet, permitting the patients
to enjoy a beautiful view of the mountains of Colorado.
Bellevue Sanatorium in Colorado Springs is 5,280 feet
high and is more of a clinic than a sanatorium. The
author was much impressed with the splendid Pottenger
Sanatorium, situated in a beautiful region 14 miles from
Los Angeles. Besides a number of pavilions, it has 60
isolated neat bungalows surrounded by small flower gar-
dens. The whole makes a very pleasing impression.
The New National Tuberculosis Sanatorium "Santa
JIaria." D. Cabret. Riv. de derecho, historia y letras,
Buenos Aires, 1918, XX, January Number.
The mortality from tuberculosis in the Argentine Re-
public has been steadily increasing during the last few
years. Over 13,000 persons died from tuberculosis in 1916.
This mortality is higher than that of England, Belgium,
the United States and several other countries. The coast
regions, where the mortality reaches 1.55 per thousand
inhabitants, is more exposed to the disease than the in-
terior. The struggle with tuberculosis was organized in
1901, when the Argentine League Against Tuberculosis
was founded. Through the initiative of this organization
a number of large sanatoriums were established which
have since been taken over by the government. In 1910
the Congress of the Argentine Republic passed a law for
the erection of five new sanatoriums, three in the moun-
tains and two on the seacoast, and for the establishment
of sixteen antituberculosis dispensaries distributed among
the larger cities of the country. The services of two Swiss
architects, who have had great experience in such con-
structions, were obtained. The plans were based on the
well-known tuberculosis sanatoriums of Davos and Leysin,
Switzerland. So far only one, the Santa Maria Sana-
torium, has been completed.
It is situated in the Cosquin valley, on the Argentine
Northern Railway, at an altitude of 760 meters (nearly
2,500 feet) above the sea. It consists of thirteen large
pavilions and has room for 782 beds. Two large galleries
have been constructed for the application of heliotherapy.
Special insolation beds, invented by Dr. Rollier, are used
for this purpose. The houses have been constructed of
the best material, and the whole group of buildings has
a pleasing and most imposing aspect. The total cost was
?1,810,000, or $2,315 per bed. The author states that the
Argentine Republic has now hospital accommodation for
21,000 tuberculosis patients, but that 42,000 more beds
ai-e necessary to fill the needs of the country.
The Hospital for Nervous Diseases Villa del Seminario at
Ferrara. G. Boschi. Med. nuova, Rome, 1918, IX, No. 1.
Very early in this war, it became evident that special
institutions were needed for the care and treatment of
soldiers who suffered from nervous and mental disturb-
ances due to modern warfare. In October, 1915, it was
decided to establish such a hospital at Ferrara, and
Cardinal Boschi, archbishop of Ferrara, generously placed
his beautiful Villa del Seminario at the disposal of the
Italian army medical department. The villa is located
about two miles from the city in the beautiful plain of
Ferrara. The hospital has 200 beds, 30 of which are set
apart for officers. The methods of treatment are psycho-
therapy, hydrotherapy, massage, thermotherapy, electro-
therapy, light work, games, such as croquet, foot-ball, etc.,
and sojourn in the blue-room. The hospital has a number
of rooms entirely colored sky-blue and with blue window-
panes. The effect of the blue light is very beneficial; it
allays tics and spasms and quiets the patient.
Hospital for Limbless Men. Cardiff., Brit. Med Jour .
Lond., 1918, I, Feb. 23.
This hospital was opened by the Prince of Wales on
February 20. It is designed to meet the needs of soldiers
and sailors who have lost limbs in the war, but it is
intended to be a permanent institution for the benefit also
of men crippled by accidents in agriculture or other
industries. The hospital is the gift of public-spirited
citizens of Cardiff. As it is necessary to test artificial
limbs in actual use, a "parade hall" was established. Here
the men make their first steps with their artificial limbs
between two parallel bars, a mirror in front showing them
their errors. In order to obtain the exact length of the
artificial limb, the man walks on boards of varying thick-
ness. For men who have lost both lower limbs, a special
appliance, an "aerial transporter crutch," has been de-
vised, consisting of pulleys and tackle, by which they can
lift themselves from their wheel-chairs into the artificial
limbs. The training of men in the use of artificial arms
is superintended by an armless collier, who has himself
invented an ingenious worker's arm. The artificial limbs
are made on the spot, so that it is easy to carry out minor
adjustments, and no man is discharged until he finds his
limb comfortable.
Male Divisions Intrusted to Female Nurses in State Hos-
pitals for the Insane. G. De Paoli, Quaderni di psichiat.,
Genoa, 1918, V, No. 2.
As many of the male nurses in the Hospital for the
Insane ai Genoa were called into the army, the director
decided to employ female nurses for male patients, as far
as possible. The patients were carefully selected and
placed in two separate pavilions of fifty beds each. These
224
THE MODERN HOSPITAL
pavilions were entirely entrusted to the care of female
nurses. The results have been most gratifying. Women
are more patient, gentle, and devoted to their work than
men. The patients, old and young, show profound respect
toward their nurses and appreciate their services more
than those of male nurses. A third pavilion with female
nurses has since been added, and, as more male nurses are
constantly called to the army, this service will be extended.
The hospital conducts a course of theoi-etical and practical
instruction for female nurses. Mothers, wives, daughters,
and sisters of men who have lost their lives in the war
are given preference.
Laundering Soiled Cotton for French Military Hospitals.
Scientific American, N. Y., 1918, CXVIII, No. 4.
Military hospitals use an immense quantity of absorbent
cotton. In Paris alone, the hospitals require more than
4,000 pounds of sterilized cotton a day. Mr. Villey, a
French chemist, conceived the plan of cleaning the soiled
cotton so as to render it fit for use again. The soiled
cotton is treated with chemicals, thoroughly washed in hot
and cold water, and dried. The laundering plant at Mont-
ferrand alone has a capacity of over 40,000 pounds of
laundered cotton a day. As the French government pays
about sixty cents a pound for American absorbent cotton,
more than a million dollars a year is saved in this manner.
It should be added that soiled cotton containing dangerous
germs is at once burned.
Necessity of Hospitalizing Typhoid Patients in Order to
Secure Efficient Treatment and to Protect the Public
Health. M. G. Lebredo. Rev. de med. v cirug. de la
Habana, 1918, XXIII, No. 5.
In Cuba, typhoid fever claims numerous victims, and
typhoid epidemics are frequent in all parts of the islands.
The author considers contact the most important mode of
transmission since, where propagation is due to water,
milk, etc., the disease is easily controlled. When an epi-
demic of typhoid raged in Santa Cruz del Norte and
decimated the population, he had all typhoid patients
brought to the hospital. In less than ten days, the disease
was under control. The author demands that all cases
which, by a laboratory examination, have been found to
be typhoid fever, be at once hospitalized, and where this
is impossible, that hospital discipline be established in the
patient's house under the supervision of the public health
authorities.
Organized Provision for the Care of the Sick in Massa-
chusetts. G. E. Whitehill, Boston Med. and Surg. Jour.,
1918, CLXXVIII, No. 7.
In answer to the question submitted by the Commission
on Social Insurance: "To what extent are wage-earners
able to avail themselves of free clinics in the state?" the
author makes the following statement:
There are 100 or more hospitals, 39 with out-patient
departments, 11 dispensaries, and about 30 nursing asso-
ciations. These institutions admit patients without regard
to race, color, sex, religion, or ability to pay. There is, on
an average, one institution for every 32,000 of the popula-
tion, with an invested capital of between forty-five and
fifty million dollars. During 1916, one person in eight
and one-half of the whole population was treated at a
hospital or dispensary, the average cost being nearly six
million dollars. The average stay in the hospital was
fifteen days. The income derived from patients at the
hospital, out-patient departments and dispensaries, in
1916, was $3,372,000, the amount of free treatment being
$2,614,000.
The Value and Limitations of Sanatorium Treatment for
Tuberculosis. St. Clair Thompson. Practitioner, Lon-
don, 1918, C, No. 2.
The value of sanatorium treatment is well established
and cannot be replaced by any other methods, but it also
has its limitations. Early diagnosis is of prime impor-
tance; delay in sanatorium treatment is fatal to success.
The cases must be carefully selected. Those with limited
lesions, only moderate constitutional disturbance, no
serious complications, originally fairly good constitutions,
and without history of massive or virulent infection, are
suitable cases. The mentality of the patient is of great
importance. Bad habits, lack of will power or intelligence
are unfavorable to a cure. Experience shows that patients
from a poor environment (laboring classes) respond
sooner and better to treatment than those who have con-
tracted the disease in a good milieu. Prolonged sojourn
in a sanatorium is necessary; a few months' treatment is
of little value.
BOOKS RECEIVED FOR REVIEW
Books received are acknowledged in this department, and such
acknowledgment must be regarded as a sufficient return for the cour-
tesy of the sender. Selections will be made for review in the interests
of our readers and as space permits.
Syphilis and Public Health. By Edward B. Vedder, A.M.,
M.D., Lieutenant-Colonel, Medical Corps, United States
Army. Published by permission of the Surgeon-General
United States Army. Cloth, pp. 315, $2.25. Lea &
Febig-er, Philadelphia, 1918.
A Proposed Basis for a Dietary for Hospitals for the
Insane — To Meet War Conditions. By H. J. Sommer,
M.D., Superintendent of Blair County Hospital for the
Insane, and P. Saha, M.D., Assistant Physician, Blair
County Hospital for the Insane, Professor Rea Scholar,
University of Illinois College of Medicine. Printed and
Distributed by Authority of the Directors of the Blair
County Hospital for the Insane, Hollidaysburg, Pa., 1918.
Framingham Monograph No. 1. General Series. 1. The
Program — Framingham Community Health and Tuber-
culosis Demonstration of the National Association for
the Study and Prevention of Tuberculosis. Donald B.
Armstrong, M.D., executive officer. Community Health
Station, Framingham, Mass., 1918.
Emergencies of a General Practice. By Nathan Clark
Morse, A.B., M.D., F.A.C.S., Surgeon to Emergency Hos-
pital, Eldora, Iowa; District Surgeon Chicago North-
western Railway, Minneapolis & St. Louis Railway; Ex-
Vice-President Iowa State Association of Railway Sur-
geons; Ex-Vice-President, Pan-American Congress; Fel-
low American Medical Association; Member of the
Society of Clinical Surgeons of North America; Author
of "Post-Operative Treatment." Cloth, pp. 450, 251
illustrations. C. V. Mosby Company, St. Louis, 1918.
Oral Sepsis in Its Relationship to Systemic Disease. By
William W. Duke, M.D., Ph.B., Professor of Experi-
mental Medicine in the University of Kansas School of
Medicine; Professor in the Department of Medicine in
Western Dental College; Visiting Physician to Christian
Church Hospital; Consulting Physician to Kansas City
General Hospital, Kansas City, Mo., and to St. Marg-
aret's Hospital, Kansas City, Kansas. Cloth, pp. 124,
170 illustrations. C. V. Mosby Company, St. Louis, 1918.
The Treatment of Cavernous and Plexiform Angiomata by
the Injection of Boiling Water (Wyeth Method). By
Francis Reder, M.D., F.A.C.S., Visiting Surgeon to City
Hospital; Consulting Surgeon to St. John's Hospital and
Missouri Baptist Sanitarium, St. Louis. Cloth, pp. 75,
illustrated. C. V. Mosby Company, St. Louis, 1918.
Interpretation of Dental and Maxillarv Roentgenograms.
By Robert H. Ivy, M.D., D.D.S., Major, Medical Reserve
Corps, United States Army; Associate Surgeon Colum-
bia Hospital, Milwaukee; Formerly Instructor in Oral
Surgery, University of Pennsylvania. Cloth, pp. 146,
with 259 illustrations. C. V. Mosby Company, St. Louis,
1918.
THE MODERN HOSPITAL
225
NEW
INSTRUMENTS
AND EQUIPMENT
VINCENZ MUELLER. Technical Editor,
GEO. W- WALLERICH. Associate Editor
Please address items of news and inquii
ments and Appliances to the editor of this
avenue. Oak Park, Illinois.
Portable Water-Bath
The water-bath shown here is both electrically heated
and regulated, and, therefore, a constant temperature is
maintained.
The apparatus is intended for use in bacteriological,
chemical, tis well as physical laboratories, where constant
temperature is absolutely imperative. The construction
is as follows: A copper container 0.75 mm. in thickness,
heavily nickel-plated inside and out, lagged with 25 mm.
magnesia-asbestos (magnesia, 85 per cent) and protected
outside by a sheet of Russia iron. The bath is attached to
an enameled cast iron base, and supplied with nickel-
De Khotinsky electrically heated and controlled portable water bath.
plated rods to which may be attached laboratory clamps
for supporting flasks, etc. Each bath is fitted with four
electric heating units, three of which may conveniently
be added, one by one, by means of the switch constituting
a part of the bath. The fourth unit is electrically con-
nected to the relay, which is automatically regulated by a
thermoregulator.
The thermoregulator is made of a solid drawn steel
tube, brass-covered and nickel-plated, filled with mercury,
and has a platinum contact attached to a regulating cap,
by means of which the bath can be regulated and set to
any desired temperature, ranging from the temperature
of the surrounding atmosphere to the boiling point of
water. Should a temperature higher than the boiling
point be needed, the water may be replaced by "Crisco,"
which can be used up to a temperature of 1G5 C, or even
higher,
A constant level water attachment is also furnished
with each bath, by means of which the water level can be
regulated within a range of 35 mm. and maintained within
one millimeter of the level at which it is set. When experi-
ments or research demand a more vigorous circulation and
regulation closer than 0.1 degree C, a small high-
speed turbine type stirrer can be attached to the bath,
which takes water from the bottom of the bath at the
rate of five liters per minute, and delivers it at the top
with an energy expenditure in the motor of 15 watts. On
the shaft of the circulating turbine is an extra pulley to
connect with the glass stirrer in the flask.
This apparatus is known as the De Khotinsky portable
water-bath and is manufactured by the Central Scientiflc
Company, of Chicago.
Gauze and Bandage-Cutting Machine
An electrically driven machine, similar to that used in
tailor shops for cutting cloth, has recently been brought
out arranged so it will cut gauze and muslin. With this
macliine it is possible to cut 100 yards of gauze, for use
as compresses, drains, wipes, sponges, etc., in about three
minutes' time. The machine cuts on the thread and all
waste is elimniated. About 50 yards of muslin for wrap-
Maimin gauze and bandage cutter.
pers, head bandages, abdominal supporters, etc., can also
be cut in three minutes. Many of these machines are
already in use in Red Cross workshops, and it would ap-
pear that this apparatus would be of great aid, especially
to the larger hospitals, where a great deal of these mate-
rials have to be used every day. This particular machine
is known as the Maimin gauze and bandage cutter.
Vacuum Bottle Automatically Regulated for Suprapubic
Drainage
That the establishment of satisfactory drainage of the
bladder after an operation of suprapubic cystotomy has
always been a most difficult problem is shown by the fact
that such a great variety of drainage apparatus, some
very simple, others complicated, have been devised in the
past, both in this country and abroad. The condition to
be met by such an apparatus is that it should not permit
226
THE MODERN HOSPITAL
any urinary leakage from the time of its application until
the wound is finally healed. It is a fact that at present
there is at least one such an apparatus in use which meets
the above-described condition, but this device is some
what expensive and as it is of the intermittent syphon
type, it occasionally disturbs the rest of the patient by the
noise produced from the periodical tilting of the metal
water container.
Dr. E. G. Davis, of Baltimore, recently presented a new
device to the profession only after it had been tried out
in practice over a long period, and he states that this de-
vice, which is illustrated below, meets every requirement.
The illustration will give a general idea as to the principle
of the apparatus. Within the large bottle is a vacuum,
which is very gradually decreased in strength by leakage
of air, through a minute capillary glass tube from the
smaller bottle, so that within the smaller bottle there is
maintained an air pressure which is slightly less than one
atmosphere. By virtue of this very slight difference in
lumen of 5 mm. which both indicates and regulates the air
pressure within the urine bottles.
The advantages claimed by Dr. Davis for this apparatus
are that it keeps the incision, patient, and bed clean and
dry and saves a great amount of gauze and bed linen, as
well as the time of doctor and nurse. It also does away
with the urinary odor in the room and keeps the patient
incomparably more comfortable than when ordinary meth-
ods of drainage are being employed.
nage apparatus.
pressure, the urine is drawn out of the bladder, through
the catheter and tube, and drips down into the small bot-
tle, replacing the air which has leaked into the vacuum.
The only care necessary is to empty the urine bottle when
it fills, and to exhaust the air from the vacuum bottle at
intervals of not less than forty-eight hours. This exhaus-
tion can be accomplished in connection with the ordinary
laboratory filter pump (which may be attached to a faucet
anywhere in the hospital) in from five to ten minutes if
the regular 8-liter bottle is being used.
The bottles V and U have a capacity of 8 and 2 liters,
respectively. Bottle V is provided with an air-tight, four-
hole rubber stopper through which pass two L-shaped
pieces of glass tubing, one straight piece and one T. Bot-
tle U has a two-hole stopper with glass tubes, as shown in
the diagram. Catheter C, at the very tip of which there
are several small perforations, passes into the bladder
through the suprapubic wound, where it is held by strips
of adhesive plaster, and is connected with the urine bottle
by a rubber tube, which has a lumen not more than 5 mm.
in diameter. The only means of communication between
bottles U and V is thi'ough the minute capillary tube
(CT) which hangs within the vacuum bottle and which
makes the rate of air flow from the smaller to the larger
bottle exceedingly slow. In the large bottle is also placed
the small U-shaped manometer of glass tubing with a
Protectors for X-Ray Operators
The necessity for protection of the body, hands, and
eyes of the x-ray operator and x-ray screen workers is
now conceded by all who have given the matter careful
consideration. The lack of such protection in days gone
by caused many of the courageous pioneers in this won-
derful work to lose their sight and even their lives. Two
new protective glasses have recently been put on the mar-
ket by F. A. Hardy & Co. — Fig. 1, under the trade name
of "Noviroent," for x-ray screen workers, and Fig. 2,
known as No. 303 X R, for the x-ray operator.
Concerning these protective devices, the manufacturers
state that, after considerable experimentation and advice
from experts, they have evolved the type of frame and
shields as shown in Fig. 1 as the best adapted for the spe-
cial needs of the screen worker. It affords complete pro-
tection from light, is light and easy when on the face, and
Fig. 1. Protective glasses for x-ray screen workers.
Fig. 2. Protective glasses for x-ray operators.
is easily put on and off. The temples are extra long and
are covered with fiber tubing, features which insure ease
and comfort to the wearer. These glasses so protect the
eyes from light, when coming out of the screen room, that
work can be started again immediately on returning to it.
The glass used in these protectors is known as "Novi-
weld" glass, which insures the needed protection, but at
the same time permits the wearer clear visual acuity.
The frame of Fig. 2, the protectors for x-ray operators,
is made of German silver, and the side screens are of solid
silver, completely protecting the eyes from outside light.
The bridge or nose-piece is easily adjustable, and may be
successfully fitted to any nose, while the wide-bearing sur-
face of the nose-rest itself guarantees freedom from dis-
agreeable pressure. The glass used is the best obtainable
lead glass, a quarter of an inch thick.
THE MODERN HOSPITAL 227
A MEETING WHICH MAY BE FRAUGHT WITH HISTORIC CONSEQUENCES
Representatives o£ the Hospitals of the Country Meet to Take Concerted Action on
Matters of Vital Importance to All— Official Program of the Atlantic City
Convention
Special Bulletin Issued from the Executive Offices, 728 Seventeenth Street, N.
HOWELL WRIGHT, Executive Secretary
W., Washington, D. C,
Plans for the Twentieth Annual Convention of the
American Hospital Association are progressing favorably.
The progi'am of papers and discussion appears nearly
complete on following pages, which also contain an
illustrated story about Atlantic City, the playground of
America, and information about opportunities to visit
hospitals and institutions in Atlantic City and other
parts of New Jersey and also in New York, Philadelphia
and Baltimore. The local committee at Atlantic City is
doing its full share in making plans to entertain the
convention. A cordial welcome is extended to the asso-
ciation and its members by the local committee, through
Dr. I. E. Leonard, chairman, and by Mr. W. F. Hanstein,
manager of the Royal Palace Hotel, the convention head-
quarters.
ATTENDANCE AT THE CONVENTION
E\ei'y effort is being made to insure a large attendance
of hospital people at this convention. A special bulletin
has been mailed to trustees, governing boards and
executives of American hospitals calling attention to the
vital hospital issues to be decided. A special invitation
has been issued to members of the Catholic Hospital Asso-
ciation of the United States and Canada; also to the
American Dietetic Association, which holds a joint session
with the American Hospital Association. Letters have
been written to boards of trustees, urging them to make
it financially possible for superintendents and others to
attend the convention. Especial attention is called to
bulletins from the war service and legislative committees
appearing herewith. For the first time the president of
the association has invited the governors of all the states
to appoint delegates to the convention.
HOTEL HEADQUARTERS AND RESERVATIONS
The Royal Palace Hotel is headquarters for all con-
vention activities. General sessions and section meetings,
as well as the commercial and non-commercial exhibits,
. will be in this hotel.
Reservations should be made early and application for
the same should be made to the hotel direct. Neither
the office of the association nor the local committee are
in a position to make reservations. The following schedule
of rates for accommodations, all of which are on the
American plan only, will apply to delegates to the con-
vention and their accompanying friends:
,. Per day ^
One person in room without private bath...$ 4.00 S 4.50 $ 5.00
Two persons in room without private bath.. 8.00 9.00
One person in room with private bath 6.00 7.00 8.00
A few single rooms with private baths at... 5.00
Two persons in room with private bath 10.00 11.00 12.00
A weekly rate will be given to any one desiring to
remain a week or longer upon notification. Also, a suite
of two rooms with bath between, twin beds in each room,
for four persons might be had for $18.00, $20.00 and
$22.00 per day for the party.
MAKE YOUR RESERVATIONS NOW
Many other hotels are available for convention delegates
and guests at Atlantic City. A list of such hotels to-
gether with the rates will be mailed shortly to all mem-
bers of the association. It is not available for publication
in this bulletin.
SPECIAL ARRANGEMENTS
Special arrangements are being made for the care of
the Catholic sisters who may be able to attend the con-
tance
learn
shall
ntion
DR. A. B. ANCKER,
President American Hospital Association
Superintendent St. Paul City and County Hospital, St. Paul, Minn.
vention. Under date of July 29, 1918, the Sister Superior
at Rita Mercy Hall, Atlantic City, writes as follows:
"I shall be pleased to help locate the sisters who shall attend said
Convention. The Royal Palace Hotel is within easy walking
as it is quite near Rita Mercy Hall ... I shall be glad
from the sisters just how many I am to secure places for,
appreciate an early conimunication with the sisters. You may
my name as you wish."
The sisters planning to attend the convention are, there-
fore, urged to write directly to Sister M. Carmelita, Rita
Mercy Hall, 210 Grammercy Place, Atlantic City, N. J.
ENTERTAINMENT
Only reasonable plans for entertainment or social func-
tions are being made by the association and the local
committee. With the nation engaged in the serious
business of making war and mobilizing all its resources
for this one purpose, it would hardly be patriotic to make
228
THE MODERN HOSPITAL
elaborate expenditures for such purposes. [Buy Liberty
Bonds and War Savings Stamps.]
Accordingly, entertainment features have been reduced
to a minimum. As no general or section meetings are
convention for convention delegates, and an automobile
ride is being planned over the boulevard to the Atlantic
County Hospital for the Tuberculosis, which is about
seven miles from Atlantic City. It should he remembered
DK. A. K. WAli.NEK,
First Vice-President. Superintendent Lakeside Hospital, Cleveland, Ohi(
ME. E. S. GILMORE,
MR. HOWELL WRIGHT.
Executive Secretary,
scheduled for Tuesday evening, it is probable that
arrangements will be made by the local committee for an
informal dance at the Royal Palace Hotel.
On the afternoon of the 2Gth there will be a life guard
drill.
Local hospitals will keep open house throughout the
MR. ASA BACON.
Treasurer, Superintendent Presbyterian Hospital, Chicago, 111.
that merely to visit Atlantic City is to be entertained in
full measure.
NON-COMMERCIAL EXHIBIT: REHABILITATION, EDUCATIONAL
AND INDUSTRIAL EXHIBIT BY RED CROSS INSTITUTE
The Red Cross Institute for Crippled and Disabled Men
has been developing both national and local activities.
THE MODERN HOSPITAL
229
In the national field it has established a bureau of re-
search to collect, digest, and disseminate the best theories
and practices relating to the cripples of foreign countries
and has also conducted a campaign of public education
in America to create a new conception of the cripple for,
in the light of results already attained abroad in the
training of disabled soldiers, the complete elimination of
the dependent cripple has become a constructive and in-
spiring possibility.
In the local field the institute has started six courses
of vocational reeducation and has also established an
emplojTnent bureau for orthopedic cases.
The plan and scope of the cripple problem, as viewed in
the experience of the Red Cross Institute, is shown in a
series of twelve charts which will be exhibited at the
convention, illustrating, first, the national program of
rehabilitation of persons disabled in the United States
DR. WIN'FORD H. SiUTH,
Trustee,
Superintendent Johns Hopkins Hospital, Baltii
e, Md.
forces; second, various forms of occupational therapy con-
ducted by the Surgeon General while the soldiers are con-
fined in the convalescent hospitals; third, industrial
operations possible for those physically handicapped as
taught at the Red Cross Institute; fourth, the technic of
placement in employment; fifth, the need of regarding the
cripple from the standpoint of his capabilities rather than
his disabilities.
As Douglas C. McMurtrie, director of the institute, has
so truly said "There is no royal road to wisdom in dealing
with the cripple. Experience is the only dependable
teacher. What little of such experience the institute may
have at any stage of its development will always be
available to others who may come to share our en-
thusiasm and aim."
COMMERCIAL EXHIBIT
The executive secretary appeals to the members of this
association to interest themselves in the plans for the
commercial exhibit and to help the association as well as
themselves by patronizing exhibitors at the convention.
There are many advantages to hospital buyers in placing
their orders direct with manufacturers and dealers who
exhibit there. Yottr especial attention is called to the
commercial exhibitors' supplement of this, the Pre-Con-
vention issue of The Modern Hospital, advertising pages
68A to 68P.
Program of Papers and Discussions
Hospital war problems will be the keynote of what is
without doubt the most important meeting the American
Hospital Association has ever held. The war has brought
the civilian hospitals of the country face to face with
serious problems. They will be discussed not only by
hospital executives but by representatives of several de-
partments of the Federal Government. The Surgeons
Generals of the Army, the Na\'j' and the Public Health
Service have appointed representatives to take part in the
program. The American Red Cross and the Federal
Vocational Educational Board will also be represented.
The program has been prepared with the thought that
MISS MARY L. KEITH.
Trustee,
Superintendent Rochester General Hospital, Rochester, N. Y.
hospital war problems shall not be merely discussed.
Concerted action is imperative. Many vital hospital
issues, concerning some of which there are wide differences
of opinion, must be settled now. It is to be expected that
the presence of representatives of the Federal Govern-
ment will contribute to this end. The following appeal
from the War Service Committee forcefully emphasizes the
"issues of the day" and the duty of American hospitals to
help settle them.
SPECIAL BULLETIN FROM THE WAR SERVICE COMMITTEE OF
THE AMERICAN HOSPITAL ASSOCIATION
To the Trustees, Governing Boards and Executives of American
Hospitals :
The great war has brought the civil hospitals of America face to
face with serious problems. They can be met and solved only by
concerted action. These problems will be discussed at the Twentieth
Annual Convention of the American Hospital Association. Vital hos-
pital issues mtist be settled at this convention. No American hospital
can afford to be without representation. This convention should not
be allowxT to pass without demonstration of the power of the organized
hospitals of America to think and to plan in terms of the present great
crisis and for the future.
The civil hospitals have gladly accepted calls for war service. They
have given willingly of their clinical and nursing staffs to the end that
the health of our boys over here and over there shall be safeguarded.
230
THE MODERN HOSPITAL
Civil hospitals are expecting more caUs for war sei-vice. The program
of the convention (which is commended to your careful attention)
includes reports by representatives of the army, the navy and other
governmental departments, who have been asked to discuss war
problems especially in their relation to civil hospitals. It is expected
that they will teU the hospitals what further calls for war service will
be made. The hospitals have a right to know.
The nursing program of the army and the American Red Cross
wiU be presented and both will be discussed from the standpoint of
the civil hospitals. No more important questions will be considered
wide differences of opinion as to the
war nursing programs. Civil hospitals
\atally concerned.
special bulletin has already pointed
at the convention. Ther
relative merits of the va
and their ciWlian clientel
The war ser\'ice committee
that all the
out your responsibility for simplifying staff
men who can be spared are released for Army service.
The legislative committee has already communicated with you about
hospitals and the inheritance tax.
committee appeals to the hospitals of America tn
of the nation at war." We look to Dr. Arthur B. Ancker,
pioneer in the municipal hospital service of this country,
to emphasize the importance of hospital standardization
by the hospitals themselves. He will advocate the adop-
tion of the proposed plan for institutional membershipi
that the association may develop along broader lines.
The report of the special committee on institutional
membership, which will be read by the chairman. Dr. A. R.
Warner, will have important bearing upon the future of
the association. It is printed in full, following the pro-
gram of the meeting, and should be read by all those
interested in the future of the association.
SECTION MEETINGS
This year, for the first time, the program has been
divided into general session and section meetings. The
Boardwalk scene. Easter Sunday. Atlantic City
send representatives to this convention and to boards of trustees to
make it financially possible for these representatives to attend.
The American Hospital Association,
By its War Service Committee,
Dr. S. S. Goldv^ateb, Chairman.
Daniel D. Test,
Dr. a. R. Warner.
Dr. W.\i. a. White.
Richard P. Borden, Secretary.
OPENING SESSION
The convention will open Tuesday morning, September
24, at 9 o'clock with an invocation by Rev. Thomas J.
Cross of Atlantic City. This will be followed by an ad-
dress of welcome by the Hon Walter E. Edge, governor
of New Jersey.
The president's address is anticipated with considerable
interest. As of first importance, it will, of course, deal
with the hospital problems of today which "are not alone
individual problems but the hospital and health problems
following sections have been approved by the trustees:
nursing; social service; out-patient work; hospital admin-
istration ; hospital construction ; dietetics. Each section
will hold two section meetings and will have one paper at
a general session of the convention. The chairmen of
the sections have arranged the section meeting programs.
So far as possible, especial attention has been given to
war-time hospital and dispensary topics. This experiment
of section meetings will be watched with great interest.
Tuesday, Thursday and Friday afternoons, the 24th, 26th
and 27th, are devoted exclusively to section meetings.
The titles and authors of the sectional papers and discus-
sions will be found in the official program as printed on a
following page.
WEDNESDAY, SEPTEMBER 25
Wednesday is devoted entirely to the consideration of
hospital problems resulting from the war.
Morning — A report of the war service committee will
THE MODERN HOSPITAL
231
be read by Mr. Richard P. Borden, secretary of the com-
mittee, and a trustee of the association. The American
Hospital Association owes a great debt to Mr. Borden.
As secretary of the war service committee he has given
much time and thought to the war activities of the asso-
ciation. At his own expense he has spent at least three
days a week in Washington since his appointment as secre-
tary of the committee. He is, therefore, familiar with
the work of the Surgeon General's office and the Council
of National Defense and their programs for handling
various hospital and medical educational problems. It is
due to the efforts of the war service committee, and
particularly to those of its secretary, that the influence of
the American Hospital Association has been felt in Wash-
ington. Mr. Borden's report will be timely and contain
first-hand information. Col. Winford H. Smith, a trustee
of the association, has been appointed as the representa-
"Social Considerations in the Rehabilitation of the Dis-
abled," will be discussed by Mr. Douglas C. McMurtrie,
director of the Red Cross Institute for Crippled and Dis-
abled Men. He will be followed by Mr. T. B. Kidner,
vocational secretary of the Invalided Soldiers' Commission
of Canada. With the aid of motion pictures he will tell
about Canada's wonderful reconstruction work. Canada's
e.xperience, as told by Mr. Kidner, will set forth many
helpful lessons to American hospitals.
Evening — Miss Georgia M. Nevins, chairman of the
section on nursing, has arranged an unusually attractive
nursing program for Wednesday evening. The nursing
program of the army and of the American Red Cross
will be discussed by Miss Annie W. Goodrich, dean of
the Army School of Nursing, who has been designated
to represent the Surgeon General of the Army, and by
Miss Jane A. Delano, director of the department of nurs-
tive of the Surgeon General of the Army and will speak
to the association about the hospital and medical educa-
tion programs of the Surgeon General's office. Colonel
Smith will, of course, be prepared to answer questions
relative to the rapidly diminishing supply of interns and
medical students, as well as questions pertaining to the
use of civilian hospitals by the Surgeon General's depart-
ment for the care of soldiers. The navy will be repre-
sented on this occasion, and the association will have an
opportunity to learn to what extent the navy is using, or
expects to use, civilian hospitals. The Surgeon General of
the Navy has designated Arthur W. Dunbar, Medical
Director of the Navy, to represent him and address him-
self to this subject. Colonel Robert L. Dickinson, medical
adviser to the General Staff of the Army, will be present
at this session.
Afternoon — Reconstruction and rehabilitation problems
will furnish the topics for this session, which will be most
interesting and profitable. Mr. C. A. Prosser, director
of the Federal Board for Vocation Education, will tell the
association about the work of this new Federal depart-
ment and what it expects of the civilian hospitals in its
rehabilitation program.
ing, American Red Cross. These programs from the
standpoint of civil hospital administration will be dis-
cussed by Miss Adelaide Nutting, Teachers' College,
Columbia University, and by leading hospital executives.
Advocates of the Army School of Nursing as well as of
the "nurses' aid" plan as a means of meeting the present
■'nursing crisis" will no doubt express themselves. This
program should provoke wide discussion.
THURSDAY, SEPTEMBER 26
At the general session on Thursday morning Mr.
Michael M. Davis, Jr., chairman, will make a report for
the committee on out-patient work, which will be followed
by two other important papers on dispensary war service
in this country and in France. Mr. Davis is well known
to the association as a leader in medical social service
work and can be counted upon to present an effective
program. Mr. N. V. Perry, constructing engineer. United
States P')blic Health Service, will give an illustrated talk
on "Hospital Construction."
FRIDAY, SEPTEMBER 27
On Friday morning the section on hospital administra-
tion will be represented at the general session by Mr.
232
THE MODERN HOSPITAL
A. B. Tipping, superintendent of the Touro Infirmary,
Louisiana. He will speak on "Extension of Civil Hospitals
for Military Emergencies." This will be followed by
the report of the legislative committee. This report will
include some reference to the incorporation of the Ameri-
can Hospital Association; hospitals and the Federal in-
heritance tax; and certain legislative aspects of sickness
and health insurance.
The following bulletin, which has been widely dis-
tributed, makes plain the necessity of concerted legislative
action on the part of this association in support of the
Rainey bill to protect the financial future of American
hospitals.
728 Seventeenth Street. Washington, D. C.
August 8, 1918.
To the Trustees. Governing Boards and Executives of Ainerican
Hospitals :
Yo" are interestefl in the financial future of hospitals. The Lepris-
has been guaranteed by further bequests to be used as endowment
funds.
A lai-ge proportion of these bequests was from large estates and
most frequently was of residues after the immediate family of the
testator were, in his estimation, sufficiently provided for.
It is the duty of the testator first to make proper provision for his
wife and children and for others of his immediate family for whom he
feels responsibility. It is customai-y, therefore, to make specific pro-
vision of adequate amounts for such dependents, and thereafter be-
queath the residue or balance to charitable uses. To secure this the
testator frequently provides that the specific bequest to dependents
shall not be diminished by inheritance taxes, but that all inheritance
taxes shall be paid from the residue.
Take, for example, an estate of $1,000,000 and suppose that the
testator determines that $900,000 shall be given to his immediate
family: leaving a residue of $100,000 to be given to a hospital. Today
this residue must be diminished by both the state and federal inheri-
tance taxes. Although, in most of the states, bequests to charitable
purposes are free from taxation, this cannot prevent the reduction of
the residue by other inheritance taxes if it be provided that such taxes
be paid therefrom. In this estate, therefore, the residue will be dimin-
Atlantic City headquarters of the American Hospital Association, Royal Palace Hotel
lative Committee of the American Hospital Association solicits your
cooperation and urges you to appeal at once to your representatives
in Congress to see that adequate legislation is provided to remedy a
very serious menace. The following statement will explain it in full.
Please urge them to support the bill (H. R. 9223) by Mr. Rainey.
Please notify Howell Wright. Chairman Legislative Committee, 728
Seventeenth Street, Washington, what reply you receive from your
representative.
■ HOSPITALS AND THE FEDERAL INHERITANCE TAX
A bill (H. R. 9223) has been introduced in Congress by Mr. Rainey
and referred to the committee on ways and means, the principle of
which is to relieve charitable institutions, including hospitals not
operated for private gain, from the unjust burden created by the new
inheritance tax law. This biU should have the earnest support of all
hospital authorities.
The Federal Inheritance Tax Law is far more dangerous in itn
effect upon hospital bcQuesls than it appears to be on a casual reading.
Unlike most of all state laws, the tax is imposed upon the net estate
of the decedent after de<Iucting from the gross estate certain stipulated
debts and expenditures : it increases with the size of the estate.
According to the census report of 1910, there was then invested in
benevolent institutions $643,000,000 with an annual expenditure of
$111,000,000, and of this amount $66,000,000 was invested in hospitals
and sanatoria. These amounts have been tremendously increased since
the census report, and as is well known, many of our larger hospitals
were instituted or made possible by bequests ; after which maintenance
ished by some $80,000 on account of the federal tax. and the balance
would disappear by reason of the state inheritance taxes. Previous to
the inheritance tax laws the hospital might anticipate the receipt of
$100,000; today it would receive nothing.
Taxation upon inheritances is just and reasonable. Charitable in-
stitutions must inevitably suffer, therefore, but to make such institu-
tions bear the major part of the burden is unjust and unreasonable
and legislative action should be invoked to bring the law within the
boundaries of justice and reason.
Hospitals must exist. Heretofore they have existed largely on
account of private benevolence. H this source of revenue is stopped
by prohibitive laws the burden must inevitably be borne by taxation
and nothing is saved, but much loss caused, by stifling charitable
impulse and interest and placing the burden of hospital support upon
the public tax gatherer.
American Hospital Association,
By its Legislative Committee,
Howell Wright, Chairman.
Oliver Bartine,
Dr. Geo. OHanlon.
HOSPITALS AND HEALTH INSURANCE
Hospitals are vitally concerned with sickness and health
insurance programs. The subject is now being studied by
several state commissions. There can be no comprehensive
system for sickness insurance without hospitals. If such
a system is adopted, it must involve the building of new
THE MODERN HOSPITAL
233
hospitals or the use of existing ones. The basis for
compensation for hospital service rendered to those pro-
tected by health insurance laws is important. What basis
shall be universally adopted? Hospitals must be consulted
in the preparation of health insurance schedules of pay-
ments for hospital and dispensary service. It can not be
left entirely to legislatures and state boards, as has been
done under workmen's compensation acts. The report will
urge legislative action along these lines by the association.
Invitations have been issued to the members and officials
of the health insurance commissions in the states of
Pennsylvania, California, Illinois, Connecticut, Wisconsin,
New Jersey, Ohio, who, it is hoped, will send repre-
help to conserve the food supplies of the nation. Dr.
Lafayette B. Mendel of Yale University will speak of the
status of the dietitian in the hospital. Miss Lulu G.
Graves, editor of the Department of Dietetics of The
Modern Hospital, formerly dietitian at Lakeside Hos-
pital, Cleveland, will tell the convention how the dietary
department of the hospital should be managed in the
interests of health and conservation. Leading hospital
superintendents will be called upon to discuss these papers.
SATURDAY, SEPTEMBER 28
On Saturday morning Mr. Cornelius S. Loder will re-
port for the committee on accounting. This will be fol-
1 Chalfonte and Boardwalk scene
sentatives to attend and take part in the discussion.
Continuing this program, Mr. Royal Meeker, United
States Commissioner of Labor Statistics, will address him-
helf to the subject "Hospitals and Health Insurance."
He is an authority on health insurance, and the associa-
tion will be fortunate indeed in his presence at the con-
vention. The discussion will be opened by Dr. Thomas
Howell, chairman of the committee on social insurance of
the association. Plans are being made to hold a confer-
ence of directors of health insurance commissions from
the several states at Atlantic City.
FRIDAY EVENING, SEPTEMBER 27
One of the features of the convention will be the joint
general session of the American Hospital Association and
the American Dietetic Association. Hospitals as well as
individuals are expected to conserve food. "Food will win
the war." On Friday evening hospital executives may ex-
pect the dietitians to tell them how they can further
lowed by other committee reports, including the time and
place committee and the election of officers for the ensuing
year.
MEETING OF REPRESENTATIVES OF EPISCOPAL HOSPITALS
At the Cleveland, 1917, convention a group of delegates
representing hospitals of the Episcopal church met and
considered some of their mutual problems. A committee
which was appointed to consult with the different church
hospitals during the past year has had several meetings.
Arrangements are being made for a meeting of this
group at the convention of the American Hospital Asso-
ciation at Atlantic City. A questionnaire has been pre-
pared bv the committee and sent to all the Episcopal hos-
pitals to be represented in the proposed conference. It is
expected that a number of institutions will be represented.
Meetings of this conference will be open to delegates to
the convention. A proarram of papers and discussions will
be arranged. The acting secretary of this conference is
234
THE MODERN HOSPITAL
Rev. Frank R. Jones, chaplain of Willard Parker Hos-
pital, foot of East Sixteenth Street, New York City.
Convention Calendar
Monday, September 23. 1918.
3 p. m. : Registration.
Tuesday, September 24, 1918.
9 a. m. : General session.
2 p. m. : Section meetings.
1. Out-patient work.
2. Nursing.
3. Social service.
4. Hospital construction.
Evening : Entertainment.
Wednesday, September 25, 1918: Hospital Problems Resulting from
the War.
9 a. m. : General session : Hospitals and Medical Education.
2 p. m. : General session : Reconstruction and Rehabilitation.
8 p. m. : General session : Nursing.
Report of the Secretary, including Membership and Publicity Com-
mittee Reports — Howell Wright, Cleveland.
Announcements — Appointment of Committee on Time and Place.
Inspection of commercial and non-commercial exhibits.
Afternoon, 2 p. m. : Section Meetings.
Section on Out-patient Work — Michael M. Davis, Jr., Boston, chairman.
Fighting Venereal Disease: A National Program Calling for Dis-
pensary Service. Speakers to be arranged in cooperation with
the office of the Surgeon General and of the United States
Public Health Service (lantern slide illustrations probably to be
included ) .
Section on Nursing — Miss Georgia M. Nevins, director Nursing Bureau,
Potomac Division, American Red Cross, Washington, chairman.
Program to be announced.
Section on Social Service — John E. Ransom, superintendent Central
Free Dispensary, Chicago, chairman.
Relation of Social Service to the Successful Treatment of Gonorrhea
and Syphilis in Hospitals and Dispensaries, Miss Ida M. Cannon,
chief of social service, Massachusetts General Hospital, Boston.
Thursday, September 26. 1918.
9 a. m. : General session.
2 p. m. : Section meetings.
1. Out-patient.
2. Dietetics.
3. Social service.
4. Hospital administration.
Friday. September 27, 1918.
9 a. m. : General session.
2 p. m. : Section meetings.
1. Hospital administration.
2. Dietetics.
3. Hospital construction.
.4. Nursinjr.
8 p. m. : Joint general session : A
American Dietetic Association.
Saturday, September 28. 1918.
9 a. m. : General session : Reports
adjournment.
Hospital Association and
nillees, election of officers.
Official Program of the Convention
TUESDAY, SEPTEMBER 21, 1918.
Morning, 9 A. M. : Gekekai. Session.
Invocation — Rev. Thos. J. Cross.
Address of Welcome — Hon. Walter E. Edge, governor of New
or his representative.
President's Address — Arthur B. Ancker, M.D., St. Paul.
Report of Special Committee on Institutional Membership
Association — A. R. Warner, M.D., Cleveland.
A Social Worker at the Admission Desk, Miss Janet Thornton,
registrar, Boston Dispensary, Boston.
Section on Hospital Construction — George O'Hanlon. M.D.. New York,
chairman.
Program to be announced.
Inspection of exhibits.
Evening
Entertainment by local committee.
WEDNESDAY, SEPTEMBER 25, 1918
Morning. 9 A. M. : General Session
Hospital Problems Resulting from the War
Hospitals and Medical Education
Report of War Service Committee — Richard P. Borden, Fall River,
Mass., secretary.
General Problems of Medical Education, the Training of Interns and
the Supply of Interns to Civil Hospitals as Related to the
Program of the Surgeon General of the Army, Col. Winford H.
Smith. (Colonel Smith will represent the Surgeon General's
office and will be prepared to discuss "The Hospital Program of
the Medical Department." Col. R, L. Dickinson, medical adviser
to the General Staff of the Army, will be present at this session.
Utilization of Civil Hospital Facilities by the Navy. Arthur W. Dunbar.
medical director United States Navy-
Public Health Nursing and the War— Miss Mary Beard, president
National Organization for Public Health Nursing.
Afternoon, 2 p. m. : Continuation of War Service Program
Reconstruction and Eehabilitation
Federal Vocational Board and the Civil Hospitals. C. -A.. Prosser,
director of the Federal Board for Vocational Education.
THE MODERN HOSPITAL
235
Social Considerations in the Rehabilitation of the Disabled, Dousrlas C.
McMurtrie, director, Red Cress Institute for Crippled and
Disabled Men.
Canada's Rehabilitation and Reconstruction Work (illustrated by mo-
tion pictures), T. B. Kidner, vocational secretary of the Invalided
Soldiers Commission of Canada.
Inspection of exhibits.
Evening, 8 p. m. : Continuation of War Service Program
M
Nursing
Georsria M. Nevins, chairman of the section on nursin?. presiding.
The Nursing Program of the Army. Miss Annie Goodrich, dean of the
Army School of Nursing (representing the Surgeon General of
the Army ) .
The Nursing Program of the American Red Cross, Miss Jane A.
Delano, director Department of Nursing, American Red Cross.
Problems and Opportunities in Out-patient Obstetrical Work or the
Problem of the Cardiac.
Section on Hospital Administration — Joseph B. Rowland, M.D., Boston,
chairman.
Description of Clinical Record System at the Presbyterian Hospital —
Adrian Lambert, M.D., Presbyterian Hospital.
Two Time-Savers, L. H. Burlingham, M.D., superintendent Barnes
Hospital.
Inspection of exhibits.
FRIDAY. SEPTEMBER 27, 191S
Morning. 9 a. m. : General Session
Extension of Civil Hospitals for Military Emergencies — A. B. Tipping,
superintendent Touro Infirmary, New Orleans, La.
Discussion.
Report of Legislative Committee— Howell Wright, Cleveland.
,The Nursing Programs of the Army and American Red Cross from the
Standpoint of Civil Hospital Administration, Miss Adelaide Nut-
ting, Teachers' College, Colvimbia University.
Discussion.
THURSDAY. SEPTEMBER 26. 191S
Morning. 9 a. m. General Session
Report of Committee on Out-Patient Work — Michael M. Davis, Jr..
Boston, chairman.
Paper on Development of War Service.
Dispensaries in France under American auspices, by a medical staff
member of the American Red Cross.
Hospital Construction (illustrated) — N. V. Perry, Constructing Engi-
neer United States Public Health Service.
Afternoon. 2 p. m. : Section Meetings
Section on Out-patient Work — Michael M. DaWs, Jr.. Boston, chairman.
Papers and discussions on: Raising Money for Dispensaries During
the War ; Dealing with Food Problems Among Dispensary
Patients ; Industrial Dispensaries as Part of a Program for
National Efficiency During the War.
Section on Dietetics (meeting of American Dietetic Association) — Miss
Lulu Graves. Chicago, chairman.
The Dietitian in Cooperation with the Red Cross, Miss Edna White,
professor home economics. Ohio State University, Columbus, Ohio.
City Dietary- Survey, Miss Lucy Gillette, director Dietetic Bureau,
Boston.
Section on Social Service — John E. Ransom, Chicago, chairman.
The Aims of Hospital Social Ser^^ce.
Training for Medical Social Ser\'ice.
Hospitals and Health Insurance — Royal Meeker, United States Com-
missioner of Labor Statistics.
Discussion led by Dr. Thomas Howell, New York, chairman com-
mittee on social insurance of the American Hospital Association.
Social Service and Hospital Efficiency — A. R. Warner, M.D., Cleveland.
Afternoon, 2 p. m. : Section Meetings
Hospital Administration — Joseph B. Howland, M.D., Boston,
Secti(
chairman.
War Time Economies — T. A. Devan, M.D., assistant superintendent
Peter Bent Brigham Hospital.
Hospital Interns — Dr. Harold W. Hersey, assistant r^ident physi-
cian, Massachusetts General Hospital.
Section on Dietetics — Lulu Graves, Chicago, chairman.
Dietary Calculations — Miss Caroline Hunt.
Food Poisoning — Dr. C. E. A. Winslow, professor public health,
Yale University.
Industrial Dietetics — Miss Freeman.
Section on Hospital Construction — George O'Hanlon, M. D., New York.
Program to be announced.
Section rr. Nursing —
Program to be announced.
Inspection of e.xhibits.
Evening. 8 p. m. : Joint General Session, American Hospital
Association and American Dietetic Assochtion
The Status of the Dietitian— Dr. Lafayette B. Mendel. Yale University.
The Management of the Dietary Department of the Hospital — Miss
236
THE MODERN HOSPITAL
ves. Editor Department of Dietetics, The Modern
Lulu G. I
Hospital.
Discussion.
SATURDAY, SEPTEMBER 28, 1918
MoBNiNO. 9 a. m. : General Session
Report of Treasurer — Asa S. Bacon, Chicago.
Report of Auditing Committee— W. E. Woodbury. M. D., New York,
Chairman.
Report. Committee on Accounting — Cornelius S. Loder, New York.
Report, Committee on Time and Place.
Election of Officers.
Adjournment.
Report of the Special Committee to Consider Institutional
Membership in the American Hospital Association
At a meeting of the trustees held in Washington June
12, 1918, a resolution was passed authorizing the presi-
dent to appoint a committee to consider the question of
so changing the American Hospital Association as to make
it an association of hospitals and other public health
institutions instead of a purely voluntary personal asso-
ciation of hospital people. Under this resolution the
standardization from election to membership. It is hoped
that the association will promptly undertake more far-
reaching and complete work along these lines.
The following copies of the constitution and bylaws
of the American Hospital Association, showing by
parentheses and underlining the parts omitted and by
capitals the parts added, is reported and recommended to
the committee on constitution and by-laws and to the
association.
A. R. Warner, Chairman.
Richard P. Borden.
Michael M. Davis, Jr.
constitution
Proposed parts printed in capitals. Parts stricken out in paren-
theses and italics.
Article I
The name of this Association shall be "The American Hospital
Association."
Article II
The object of this Association shall be, to promote the welfare of
the people so far as it may be done by the institution, care and man-
undersigned committee was appointed and makes the
following report:
There is in the opinion of the committee a need for
an association of American hospitals to promote the
welfare of American hospitals, develop their efficiency,
enlarge their field of usefulness and correlate it with
other forms of public health and social work and at all
times to protect the interests of hospitals and hospital
work. Corresponding associations have been formed by
various commercial interests with uniform success. There
seems to be no fundamental reason why an association of
hospitals would not be equally successful.
In order to provide for the organization of a strong,
efficient association of American hospitals and in order
to make it possible for and encourage this association to
become at once active in developing the common interests
and in order that the association should be alive and active
every day of the year, numerous changes in the constitu-
tion and by-laws seem necessary.
It is the hope of the committee that this change in the
American Hospital Association shall be the first step in
the standardization and classification of hospitals by this
association. Although this standardization and classifica-
tion seems particularly a task of the American Hospital
Association, it has not been thought advisable to attempt
this in the constitution beyond the simple, yet effective
agement of hospitals and dispensaries with efficiency and economy, to
aid in procuring the cooperation of all organizations with aims and
objects similar to those of this Association : and in general, to do all
things which may best promote hospital efficiency.
Article III
(Section 1. The membership of this Association shall be active,
associate and honorary. The active and associate members may bc'
come life members in their respective classes upon the payment of $50
for active and $25 for associate membership.)
SECTION 1. THE MEMBERSHIP OF THIS ASSOCIATION
SHALL BE—
A. INSTITUTIONAL.
ANY CORPORATION OR ASSOCIATION ORGANIZED FOR THE
PROMOTION OF PUBLIC HEALTH OR FOR THE CARE OR
TREATMENT OF THE SICK OR INJURED SHALL BE ENTI-
TLED TO MEMBERSHIP SUBJECT TO THE FOLLOWING:
APPLICATIONS FOR INSTITUTIONAL MEMBERSHIP SHALL
BE ADDRESSED TO THE EXECUTIVE SECRETARY IN WRIT-
ING. SIGNED BY A DULY AUTHORIZED REPRESENTATIVE OF
THE CORPORATION OR ASSOCIATION: THEY SHALL BE RE-
FERRED TO THE MEMBERSHIP COMMITTEE AND THE APPLI-
CANT SHALL BECOME A MEMBER UPON RECEIVING THE
APPROVAL OF THE MAJORITY OF THE MEMBERSHIP COM-
MITTEE AND UPON THE PAYMENT OF THE INITIATION
FEES AS FOLLOWS: HOSPITALS WITH A CAPACITY OF LESS
THAN 100 BEDS SHALL PAY TEN DOLLARS: THOSE FROM
THE MODERN HOSPITAL
237
100-250 BEDS. INCLUSIVE. SHALL PAY TWENTY DOLLARS;
ALL OVER 250 BEDS SHALL PAY THIRTY DOLLARS: ALL
OTHER ORGANIZATIONS ELIGIBLE TO MEMBERSHIP SHALL
PAY TEN DOLLARS.
CONSTITUENT INSTITUTIONAL MEMBERS SHALL BE EN-
TITLED TO APPOINT AS THEIR REPRESENTATIVES IN THE
ASSOCIATION ANY PERSON OR PERSONS WHO ARE ELIGIBLE
TO ACTIVE OR ASSOCIATE MEMBERSHIP IN THE ASSOCIA-
TION, AND OF THE NUMBER SO APPOINTED NO MORE THAN
THREE. INCLUDING THE SUPERINTENDENT, SHALL HAVE
ALL THE PRIVILEGES AND AUTHORITY OF ACTIVE PER-
SONAL MEMBERS AND SHALL BE SO DESIGNATED, AND
OTHERS SO APPOINTED SHALL HAVE THE PRIVILEGES OF
ASSOCIATE PERSONAL MEMBERS.
B. PERSONAL.
Active PERSONAL members shall be those who at the time of
their election are trustees or superintendents, or assistant superin-
tendents, of hospitals, or members of the medical staffs of hospitals.
Section (5) 3. Honorary PERSONAL membership AFTER AP-
PROVAL OF THE MEMBERSHIP COMMITTEE may be suggested
at any session of the Association by any member for any person who
by reason of public or private service, or for any other reason, should
be entitled to such recognition : and such person may be elected an
honorary PERSONAL member by a majority vote of those present at
any subsequent session of the Association.
Honorary PERSONAL members shall have all the privileges of
active PERSONAL members, except \oting at meetings of the Associa-
tion. They shall be exempt from the payment of dues.
Article IV
OFFICE :is
Section 1. The officers of the Association
Vice-Presidents, an EXECUTIVE Secretary,
of Trustees as hereinbefore provided.
The EXECUTIVE Secretary shall ser\e
of Trustees.
Section 2. The above officers, other than the Board of Trustees,
shall be a President, three
a Treasurer, and a Board
Secretary of the Board
Bathing
taken from Steel Pit
however such officials may be designated. Any person once an active
PERSONAL member may continue such membership so long as the
rules of the Association are conformed with.
Associate PERSONAL members shall, at the time of their election,
be heads of any executive, administrative, or educational department
of a hospital, other than as designated in Section 2, or contributors to,
or members of, any association or board, the object of which is the
foundation, maintenance or improvement of hospitals or the promo-
tion of organized charities for the improvement of health. Associate
PERSONAL members may hold office, but shall not have the right to
vote at meetings of the Association.
Applications for active or associate PERSONAL membership shall
be in writing, addressed to the EXECUTIVE Secretary, and shall be
endorsed by one or more members of the Association. They shall be
referred to the Committee on Membership : and the applicant shall
becoiae a member upon receiving the approval of a majority of said
Committee, and upon payment of an initiation fee of five dollars for
active and two dollars for associate membership, which shall cover the
dues payable at the next convention of the Association after election.
SECTION 2. Upon attaining any of the offices designated in Sec-
tion 2 an associate PERSONAL member may become an active
PERSONAL member by (the payment of three dollars) COMPLET-
ING THE PAYMENT OF THE DUES FOR ACTIVE PERSONAL
MEMBERS AS PROVIDED IN THE BY-LAWS.
Garden Pier in background at right
shall be elected at each convention, shall assume the
close of the convention,
tion next succeeding, o
and installed.
nd shall serve until the close of the conven-
until their successors are regularly elected
Article V
TRUSTEES
There shall be a Board of five Trustees, which shall have charge
of the property and financial affairs of the Association, and shall hold
title thereto under the name of "Ti*ustees of the American Hospital
Association." The President and Treasurer shall constitute two of
said Trustees, and one Trustee shall be elected annually, at the con-
vention, to ser\-e for three years, excepting that in 1916 ; one of said
Trustees shall be elected for one year, one for two years, and one for
three years. Trustees shall serve until their successors are elected.
The Board of Tiiistees shall, always subject to the vote of the Asso-
ciation, have general control and management of the business of the
Association, and may appoint and fix the salaries of such officers and
agents as it may deem necessary and expedient and establish rules and
rates for ihe use of such facilities as it may in its judgment pro\ide.
(They shall make an annual report to this Association.)
Article VI
SECTIONS
In order to facilitate the work of the Association, sections may be
formed and discontinued from time to time, as the Trustees may by
238
THE MODERN HOSPITAL
vote determine. Such sections may be Eeo3raphic, in order that recog-
nized meetings of the Association may be held in various parts in
places not easily accessible to all members, or may be departmental
in their nature and devoted to any recognized branch of hospital work.
Proceedings of any authorized section of the Association approved by
the Board of Trustees may become a part of the proceedings of the
Association, and any resolution adopted by a geographic section shall
be recognized as a motion duly made and seconded by any general
session of the Association, and vote of the general Association shall
be taken thereon.
Article VII
ANNUAL DUES
In order to proWde funds for the maintenance of the Association,
BOTH INSTITUTIONAL AND PERSONAL members shall pay annual
dues as may be determined by the By-Laws.
Article VIII
{All vacancies in office and in the Board of Trustees shall be filled
by vote of the Board of Trustees.) ANY VACANCIES OCCURRING
BETWEEN THE REGULAR ANNUAL MEETINGS IN THE
OFFICE OF THE PRESIDENT, THE VARIOUS VICE-PRESI-
his absence, by a Vice-President, upon the written petition of not
fewer than ten (10) members. This petition shaU recite the object of
the meeting. The President, through the Secretary, shall give notice
of not less than sixty (60) days before the proposed time of such
special meeting to each member of the Association, which notice shall
also recite the object of the meeting.
Section 3. A quorum of the Association shall consist of not fewer
than thirty (30) VOTING DELEGATES or active members.
Section 4. Meetings of sections shall be held in accordance with
the rules established by the enrolled members of the section hereinafter
provided ; provided, however, that such meetings shall not interfere
with any general session of the Association.
Artici-E II
ELBCTIONS
Section 1. All officers shall be elected by ballot, excepting where
it is otherwise ordered.
Section 2. A majority of the votes cast shall constitute an election.
Section 3. {Only active members shall be entitled to vote) ONLY
THE DELEGATES OF THE CONSTITUENT INSTITUTIONAL
MEMBERS SO AUTHORIZED BY ARTICLE III. SECTION 1, AND
Atlantic City Hospit.il
DENTS. TREASURER, EXECUTIVE SECRETARY OR BOARD OF
TRUSTEES, SHALL BE FILLED TEMPORARILY BY VOTE OF
THE BOARD OF TRUSTEES; ANY OTHER VACANCIES SHALL
BE FILLED TEMPORARILY BY APPOINTMENT OF THE PRESI-
DENT; AND SHALL HOLD OFFICE UNTIL THEIR SUCCESSORS
ARE ELECTED BY THE ASSOCIATION.
Article IX
AMENDMENTS
The Constitution and By-Laws may be amended by vote of not less
than two-thirds of the members present and voting at a recognized
general, session of the Association ; provided, however, that proposed
amendments shall be submitted in writing at a recognized, general
session, and shall not be acted upon at the session at which they are
proposed, but may be at any subsequent session.
BY-LAWS
Proposed parts printed in capitals. Parts stricken out in paren-
theses and italics.
Article I
Section 1. There shall be an annual meeting or convention of the
Association, held at a time and place fixed by vote of the Association,
or, if not so determined, by the Board of Trustees. (The Committee
on Local Arrangements shall, in conjunction with) The President and
the EXECUTIVE Secretary SHALL arrange programs for the con-
vention.
Section 2. Special meetings may be called by the President, or in
ACTIVE PERSONAL MEMBERS SHALL BE ENTITLED TO VOTE.
Article HI
DUTIES OF officers
Section 1. The President shall preside at all meetings of the Asso-
ciation, AND OF THE BOARD OF TRUSTEES. OF WHICH HE
SHALL BE THE CHAIRMAN. He shall appoint all committees, un-
less, by vote of the Association, other provisions shall be made. He
shall be, ex officio, a member of all standing and special committees.
Section 2. The Vice-Presidents shall, in the order of their rank,
in the absence of the President, perform his duties.
(Section 3. The Secretary fhall keep the minutes of the meetings
and records of the Association in bocks provided for these purposes.
The Secretary shall furnish to the Committee on Publication within ten
days after the adjournment of the regular convention, a correct copy
of the minutes thereof for publication in the "Proceedings.")
(Section 4. The Secretary shall conduct the correspondence of the
Association, and shall keep on file all letters and correspondence, to-
gether with all the replies thereto, and perform such other duties that
may be required of him by the Trustees.)
Sections 3 and 4 combined to read as follows: SECTION 3. SUB-
JECT TO INSTRUCTIONS FROM THE ASSOCIATION OR FROM
THE BOARD OF TRUSTEES, THE EXECUTIVE SECRETARY
SHALL BE THE GENERAL EXECUTIVE OFFICER OF THE
ASSOCIATION WITH DUTIES, RESPONSIBILITIES AND PRIV-
ILEGES SUCH AS GENERALLY ACCOMPANY SUCH EXECUTIVE
THE MODERN HOSPITAL
239
POSITIONS. HE SHALL KEEP THE MINUTES OF THE MEET-
INGS AND THE RECORDS OF THE ASSOCIATION IN BOOKS
PROVIDED FOR THESE PURPOSES. SUBJECT TO THE ORDER
OF THE TRUSTEES. HE MAY SERVE AS SECRETARY OF
STANDING COMMITTEES. EXCEPT THE COMMITTEE ON THE
NOMINATION OF OFFICERS. AND PERFORM SUCH OTHER DU-
TIES AS THE ASSOCI.\TION AND THE BOARD OF TRUSTEES
SHALL DIRECT. UNDER THE DIRECTION OF THE TRUSTEES
THE EXECUTIVE SECRETARY SHALL REPORT TO THE ASSO-
CIATION THE PROCEEDINGS OF THE TRUSTEES AND ALSO
MAKE SUCH REPORT OF HIS OWN SERVICES AS MAY BE
ADVISABLE.
Section (5) 4. The Treasurer shall receive all dues and other
moneys of the Association and shall deposit and account for same,
under the direction and control of the Board of Trustees. He shall
give to said Board such bond as it shall determine for the faithful
performance of his trust. Such bond shall be in the custody of the
tees aa VACANCIES EXIST. The action of this Committee is at all
limes subject to the approval of the convention.
Section 3. {The Membership Committee shall receive, consider and
act upon candidates for membership, and shall report resxdts to the
ventu
THE MEMBERS OF THE MEMBERSHIP COMMITTEE SHALL
CONSIDER ALL APPLICATIONS FOR MEMBERSHIP, DETER-
MINE THE ELIGIBILITY OF THE APPLICANT AND EXPRESS
THEIR APPROVAL OR DISAPPROVAL THEREOF TO THE EX-
ECUTIVE SECRETARY.
Section 4. The Committee on Constitution and Rules shall consider
and report on all proposed amendments in the Constitution and By-
Laws and all Rules of Order.
Section 5. The President shall have the power to appoint such
special Committees as may be deemed desirable.
(There shall be a Standing Committee on Out-Patient work, to
consist of three members appointed by the President. The terms of
.
li^^ISi^
n&H^attsMBMHHSU^Ktm^^l
IHst* •TO^j
ElHUJ^^HIHH
-^1
\ 1
— "
.Atlantic City
President. All disbursements and expenditures shall be made under
the direction of the Board of Trustees and subject to its rules and
requirements. The Treasurer shall keep proper books of account, and
shall present a report of the finances of the Association at the annual
meeting.
Article IV
Section 1. The President shall, immediately after his election, ap-
point a committee on Local Arrangements to consist of the President
AND EXECUTIVE SECRETARY ex officio (tio! less than four addi-
tional members) AND SUCH ADDITIONAL PERSONS AS HE MAY
DEEM ADVISABLE AND ALSO the following standing committees
of three members each ; namely, A Committee on Constitution and
Rules, a Committee on Nomination of OfRcers, {A Committee on De-
velopment of the Association) a Legislative Committee. A MEMBER-
SHIP COMMITTEE, and {Publication Committee, composed only of
active members) a COMMITTEE ON TIME AND PLACE OF NEXT
MEETING, COMPOSED OF DELEGATES OR ACTIVE MEMBERS
AND THE PRESIDENT SHALL ALSO APPOINT A STANDING
COMMITTEE ON OUT-PATIENT WORK TO CONSIST OF THREE
MEMBERS APPOINTED BY THE PRESIDENT. THE TERMS OF
OFFICE AT THE FIRST APPOINTMENT SHALL BE SO AD-
JUSTED THAT ONE MEMBER SHALL GO OUT OF OFFICE
ANNUALLY. THIS COMMITTEE SHALL UNDERTAKE SUCH
STUDY OR ACTIVITY AS MAY ADVANCE PROGRESS OF OUT-
PATIENT SERVICE AND SHALL REPORT TO THE ASSOCIA-
TION.
Section 2. The Committee on Nomination shall nominate to the
convention the names of the candidates for President, three Vice-Presi-
dents, EXECUTIVE Secretarj', Treasurer, and ONE OR MORE Trus-
office at the first appointment shall be so adjusted that one member
shall go out of office annually. This Committee shall undertake such
study or activity as may advance progress of out-patient service and
shaU report to the Association.)
{Section 6. The Committee on the Development of the Associa-
tion shall present annually a report on the further development of the
.Association's work.)
{Section 7. The Committee on Publication shall receive the min-
utes of the Secretary concerning aU transactions of the Association or
its sections, and all papers read at any session thereof; and authorize
or forbid the publication of all or any part of such minutes or papeis
as a part of the proceedings of the Association in the report of the
Association or in any paper or magazine approved by the Comitiittee.)
Section (8) 6. The Legislative Committee shall so far as possible
inform itself concerning all legislative procedure affecting the Associa-
tion or the interests which it represents, (and cojnmunicate the same
to the Association by an annual report or by such other means as the
Trustees may approve.)
SUBJECT TO THE APPROVAL OF THE ASSOCI.\TION OR
BOARD OF TRUSTEES. IT SHALL ACTIVELY SUPPORT ALL
DESIRABLE LEGISLATION AND ACTIVELY OPPOSE ALL UN-
WISE LEGISLATION.
Article V
DUES
• SECTION 1. CONSTITUENT INSTITUTIONAL MEMBERS
SHALL PAY ANNUAL DUES AS FOLLOWS: HOSPITALS OF
LESS THAN 100 BEDS SHALL PAY ANNUALLY $10. HOSPITALS
OF 100-250 BEDS SHALL PAY ANNUALLY $25, HOSPITALS OF
MORE THAN 250 BEDS SHALL PAY ANNUALLY $50. ALL
240
THE MODERN HOSPITAL
OTHER INSTITUTIONAL MEMBERS SHALL PAY ANNUALLY
THE SUM OF SIO. STATES, COUNTIES AND MUNICIPALITIES
SHALL PAY IN ACCORDANCE WITH THE ABOVE SCHEDULE
FOR EACH INSTITUTION ACCEPTED TO MEMBERSHIP.
Section (1) 2. Dues of active PERSONAL members shaU be $3
and of associate PERSONAL members $2 for each calendar year.
Life PERSONAL members are exempt from the payment of annual
dues. Dues shall be payable on or before the first day of March of
each year at the office of the EXECUTIVE Secretary.
Section (2) 3. If said dues are not paid on or before the closins
of the annual convention for the current year, the EXECUTIVE Sec-
retary shall notify the members in arrears, enclosing a copy of this
section ; and if said dues are not paid on or before the succeeding first
day of January, the delinquent member shall be suspended and there-
after shall not be entitled to receive notices, or copies of the trans-
actions, or to participate in the meetings until all arrears are paid
in full.
Section (3)4. At any time within three years after the date when
dues are first required to be paid a member who has been suspended
shall be reinstated upon the payment of the amount due at the time
of suspension. Otherwise membership in the Association shall be
terminated.
Article VII
SECTIONS
Whenever a section is estabUshed by the ASSOCIATION OR Trus-
tees as provided in the constitution, the President shall appoint a
chairman and secretary thereof ; and thereupon any DELEGATE OR
member of the Association may become a member of such section by
enrollment therein. When ten (10) or more DELEGATES OR mem-
bers have so enrolled, the chairman shall call a meeting of such DELE-
GATES OR members, and they may thereupon make proper rules and
by-laws for the guidance of such section, subject to the approval of
the Trustees ; and such rules may piovide for the method of holding
meetings, election of officers, and other matters necessary or important
for the proper conduct of the section. The chairman and secretary
appointed by the President shall act until their successors are chosen
by the members of the section in accordance with the by-laws estab-
lished by such section.
Article VIII
GUESTS
DELEGATES AND members of the Association may have the priv-
ilege of inviting guests to the meetings, under such rules and regula-
tions as the Trustees may from time to time provide. Guests thus
introduced shall be pennitted to participate in discussions.
I M n I r riiiii i t i
St. Luke's Hospital, New York,
of the hospitals which deleErate
the meeting.
ill be able to inspect
' way to or from
Article VI
PUBLICATION OF PROCEEDINGS
Section 1. The EXECUTIVE Secretary shall furnish the minutes
and proceedings of the regular meetings for publication as soon there-
after as practicable.
Section 2. The EXECUTIVE Secretary shall furnish to each mem-
ber, except as provided in Article V, Section 2, a copy of this pub-
lication.
Section 3. (The Secretary shall, upon certification of the Treasurer)
THE TREASURER SHALL UPON THE CERTIFICATION OF THE
EXECUTIVE SECRETARY pay all bills for printing and pubUcation
of the proceedings of the regular conventions.
Section 4. No paper shall be published in the minutes or in any
magazine or paper as a part of the transactions of this Association
except with the approval of the (Publication Committee) TRUSTEES.
All papers read at any session of the Association or its section shall
become the property of the Association, and when so requested (By
the Committee on Publication) The Board of Trustees (shall) MAY
cause the same to be copyrighted in the name of the Trustees ; but,
unless prohibited by (The Committee on Publication) THE TRUSTEES
the authors of all papers read at sessions of the Association or its
sections may cause the same to be published, and, if approved by the
(Committee on Publication) TRUSTEES they may be published as
a part of the transactions of the Association. No paper or magazine
shall be entitled to the exclusive publication of any paper read before
the Association or its sections except by vote of the Trustees.
Article IX
DISCIPLINE
Section 1. All charges of violation and infraction of rules or unbe-
coming conduct shall be referred to a special investigating committee
of five appointed by the President.
Section 2. Due notice of the charges shall be given to the alleged
offender, in writing, by the EXECUTIVE Secretary of the Association.
Section 3. The Association shall have the right and authority to
reprimand, suspend and expel any DELEGATE OR member guilty of
violation of any of the provisions of the constitution or by-laws of
the Association, after a full and fair investigation shall have been
made.
Section 4. A four-fifths vote shall be necessary to sustain the action
of such committee.
Article X
Amendments
These by-laws may be amended as provided by Article IX of the
constitution.
Special Opportunity for Delegates to Visit Hospitals in
New York City, Philadelphia and Baltimore
Arrangements are being completed which will give mem-
bers of the association and delegates to the convention an
opportunity to go in groups to visit and inspect leading
THE MODERN HOSPITAL
241
of the Rockefeller
hospitals in New York, Philadelphia, and Baltimore. A
committee has been appointed in each city to look after
delegates who may wish to stop over and visit hospitals
in these cities on the way to or from the convention.
The chairman of the New York Committee is Dr. Thomas
Howell, New York Hospital, 8 West Sixteenth street,
New York City; the chairman of the Philadelphia com-
mittee, Mr. Daniel D. Test, superintendent Pennsylvania
Hospital, Eighth and Spruce streets, Philadelphia; the
chairman of the Baltimore committee, Dr. R. B. Seem,
assistant superintendent Johns Hopkins Hospital. Indi-
vidual delegates desiring to visit these cities on the way
to the convention may write to the above-named chairman
for advice and information. Delegates wishing to make
Bellevue Hospital, New York. (Photograph by courtesy of the New York Eil
acknowledgment is made.)
242
THE MODERN HOSPITAL
any of the trips after the convention should notify the
executive secretary at Atlantic City, who, with the respec-
tive chairmen, will endeavor to complete necessary
arrangements.
Hospitals and Other Institutions in New Jersey Which
May be Visited by Delegates to the Convention
ATLANTIC COUNTY HOSPITAL FOR TUBERCULOUS DISEASES
Dr. I. E. Leonard, chairman of the local committee on
arrangements, is arranging an automobile trip for dele-
gates to the Atlantic County Hospital for Tuberculous
Diseases, located at Northfield, N. J., seven miles from the
city, over the boulevard. This is a new county institution,
built under the terms of the 1912 act of the New Jersey
legislature empowering county boards to establish county
Mount Sinai Hospital, New York.
hospitals for the care and treatment of persons suffering
from tuberculosis. It is an attractive, modern institution.
In each of the two years of its operation, according to
official reports, it has cared for over 100 patients. The
superintendent is Dr. Clyde M. Fish.
THE TRAINING SCHOOL AT VINELAND, N. J.
A cordial invitation has been issued to the members of
the American Hospital Association and delegates attend-
ing its twentieth annual convention to visit two great
institutions for the feeble-minded at Vineland — the Train-
ing School for the Feeble-Minded and the New Jersey
State Institution for the Feeble-minded. Delegates wish-
ing to visit these institutions on the way to the convention
should communicate now with the executive secretary or
Hospital, New York.
THE MODERN HOSPITAL
243
^■n^'^B
IS 0 O
Johns Hopkins Hospital, Baltimore
at the convention for a later visit. A visit to either one of
these institutions is an education in itself. The Training
School is a large institution, covering many acres with a
number of buildings. There are 120 girls and 265 boys
at the Training School and 100 at Menantico Colony. The
work being done under the direction of Dr. E. R. Johnstone
is modern, progressive and scientific. Results are being
accomplished.
NEW JERSEY STATE INSTITUTION FOR THE FEEBLE-MINDED
The State of New Jersey has adopted a progressive
policy for the institutional care of the feeble-minded. The
New Jersey State Institution for the Feeble-Minded at
German Hospital. Philadelphia
244
THE MODERN HOSPITAL
Vineland, which now has a capacity for 750 patients, is
the present expression of a definite plan of institutional
development which will eventually include accommodations
for 1,500 feeble-minded in a central plant; colonies for
1,000 additional patients; a research department; and
special classes in the public schools for feeble-minded
children not a social menace. The rapidity with which
this plan will develop depends upon the
state legislature. A visit to the institution
and a talk with the superintendent will con-
vince one that the framers of the New Jer-
sey plan recognize the problem of feeble-
mindedness. Dr. Madeleine A. Hallowell,
medical director and superintendent, ex-
tends a cordial invitation to delegates.
Atlantic City-
-the Playground of the
World*
Atlantic City, the playground for the
whole world and the greatest seaside health
resort, has grown from a few summer cot-
tagers in 1854 to a city of 50,000 permanent
citizens. Dr. Jonathan Pitney, of Absecon,
N. J., recognized in the large island of
sand five and one-half miles to the south-
east of the New Jersey coast the unpre-
cedented advantages for giving his patients
the open air treatment for disease. While
not the first to visit Absecon Island, on
which Atlantic City is located, he was prac-
tically the real promoter of the present
magnificent city.
With a permanent population of 50,000,
the city increases to 300,000 by the height
of the season in August; and, what is more
gratifying, this large army is properly
housed, dined and entertained. The capac-
ity of the hotels without crowding ranges
from 1,100 down to the small boarding
house and cottage. It is a "city of hotels."
With 100 large hotels, over 900 smaller ho-
tels and boarding houses and about 9,000
cottages and other buildings, one can read-
ily realize the ease with which one's comfort can be
met. Atlantic City's one aim is the entertainment
and comfort of her guests; she can not be classed as a
manufacturing or commercial center. Its terminus is
in the ocean and its only commodities in trade are fresh
air, sunshine, good accommodations, wholesome food, pure
water and the pleasure and health of its guests.
THE BOARDWALK
Atlantic City's Boardwalk is unique; nowhere in the
world can one find its duplication — a steel and reinforced
concrete substructure with a Georgia pine deck, elevated
from 5 to 15 feet above the beach, 8 miles long and 20
to 60 feet in width. On one side is an unobstructed
view of the ocean and beach, while the other is lined by
hotels, places of amusement and bazaars. It is on this
structure that one will find a regular kaleidoscopic mov-
ing mass of humanity representing every state in the
Union and every civilized nation of the earth ; "Babel let
loose" as one expressed it. In fact, "Meet me on the
Boardwalk at Atlantic City" has become one of the world's
by-words.
Six piers, each over 1,000 feet in length, extend from
the Boardwalk into the sea, and on them one can find
amusement, recreation, fishing, or a peaceful rest at all
times of the year. Open in summer and heated in win-
ter, the music halls provide the very best high-class
music.
RECREATION
Surf-bathing is the most popular form of amusement
and recreation in summer. The beach is safe, and
One of the buildings at Burlington County Colony for the Feeble Minded.
l-eel)le-minded boys of Menantico Colony hoeing sweet-potatoes. Farm work i
particularly to such boys, and they are capable of being very useful at it.
THE MODERN HOSPITAL
245
gently to deep water 50 to 100 yards from shore, is cov-
ered with fine sand, and is free from rocks and other in-
jurious features. Sea ropes are unknown. Many bathers
enjoy the surf during the winter months. Indoor
swimming pools are also at one's command.
Yachting and fishing are two forms of entertainment
and recreation always available. Here one can have a
sail on the bays and thoroughfares on smooth water or
on the ocean, where the roll and toss of the waves are
fully experienced. Atlantic City is not a port of entry,
but the inlet channel is now on the United States Gov-
Sun bath porches at Children's Seashore House. (Note the mothers'
cottages below the porch.)
House, Atlantic City.
ernment and State of New Jersey appropriation bills
and will be deepened to accommodate the largest pleasure
craft. The whole city and Boardwalk are so carefully
policed at all time of the day and night that ladies
can come and go without escort or fear of molestation.
The Country Club, located at Northfield, seven miles
away, affords every opportunity for golf and other out-
door sports at all seasons and can be reached by trolley
at any hour.
THE ROLLING CHAIR HABIT
The rolling-chair habit has grown to such phenomenal
proportions that not only do invalids use these easy
vehicles, but the average visitor can make use of them
as he would of the taxicabs and carriages. This affords
every opportunity to enjoy the climatic influences and
the beauties of the sea.
THE CITY ITSELF
Just a word or two about the city in general. It is
ruled by s commission of five members. There are twelve
school buildings graded to the highest standard, preparing
pupils for any college; thirty odd churches representing
all denominations; a most eflScient paid fire department
of fourteen separate companies; a thoroughly trained
corps of municipal life guards and medical men on the
beach during surf -bathing seasons; nine banking institu-
tions and trust companies of the highest rank — in fact,
everything that goes to make an up-to-date city. The city
streets are well paved and are kept in a perfectly clean
condition by the city's "white wing corps." There is no
city in the world better able to care for conventions of
all sizes and to give almost unlimited accommodation of
the very best kind without crowding and over-charging.
An influx of 10,000 to 20,000 people is no longer a novelty,
and they are so well cared for and with such little effort
that their presence is scarcely noticed except on the
Boardwalk.
Hotels range from the palatial beach front structures of
steel and concrete to the more unobtrusive little board-
ing houses on the side streets. Money has not been spared
to provide for the comforts of their guests. One can
find every home comfort at command, winter and sum-
mer. The rates charged by these hotels are within the
reach of ail, and are proportionately low when compared
with other cities. Many of them supply hot and cold,
fresh and sea-water baths with each suite of rooms. Spe-
cial diet kitchens for the preparation of food for invalids
and the sick are noticeable features of the best hotels.
246
THE MODERN HOSPITAL
EXCELLENT RAILROAD SERVICE
Few cities have better railroad service than Atlantic
City. The Pennsylvania, the Reading, and Central Rail-
road of New Jersey and electric lines have Atlantic City
branches. The city is reached in one hour from Phila-
delphia by some of the fastest trains and in three hours
from New York.
Hospitals of Atlantic City
THE CHILDREN'S SEASHORE HOUSE FOR INVALID CHILDREN
Atlantic City has in the Children's Seashore House
for Invalid Children the largest children's institution de-
voted to thalasso-therapy in America. It has accommoda-
tions for four hundred and annually cares for over thirty-
six hundred persons. It is also the oldest institution of
the kind in the country.
It was organized in 1872 and began its work then in a
little cottage containing thirteen beds. The following
year it was opened in a building erected right on the beach
for its special purposes, with accommodations for forty
children.
As its work grew during the succeeding twenty-eight
years, the capacity of this building was increased until
there was room in it and its dependencies for two hun-
dred and twenty-five patients.
In 1902 its old quarters were abandoned, and its present
commodious group of buildings was erected with accom-
modations in all its departments for over four hundred.
The institution was intended for the sick and delicate
children of Philadelphia, and among its first inmates
were children from the hospitals of the city. During the
first thirty-eight years of its existence it was open in
summer only, but since 1910 some portion of the institution
has been open throughout the year.
At first only children under twelve years of age were
admitted, but gradually its scope has been widened until
now it receives children of all ages, from the youngest
infant to the girl of twenty, and in its summer camp off
in the sand dunes, boys of sixteen.
The work of the institution may be classified under
four heads: First, the baby-saving work; second, its
fortifying work for delicate children not yet ill; third, its
work for convalescents; fourth, its work for children with
bone and gland diseases.
MUNICIPAL HOSPITAL FOR THE TREATMENT AND DETENTION
OF CONTAGIOUS DISEASES
This institution has accommodations for 64 patients,
and its capacity can easily be increased to 100. It is a
handsome, artistic, fireproof building. The hospital has
four wards, one for diphtheria, one for measles, one for
smallpox and the fourth for scarlet fever. The adminis-
tration building is occupied by the offices, the drug room,
the kitchen and dining rooms and bedrooms for members
of the staff. In addition to the public wardj there are
handsome private rooms, either single or en suite, which
may be engaged by patients who may be willing to pay
in proportion to the accommodations placed at their dis-
posal.
ATLANTIC CITY HOSPITAL
Atlantic City Hospital is an incorporated charitable
institution. It is a general medical and surgical hospital
with an average daily attendance of hospital patients in
1917 of 76. It admits pay, part-pay and free patients,
and conducts a training school for nurses. Its general
superintendent. Miss F. Virginia Ludekens, is a member
of the American Hospital Association and of the local
committee. She will welcome delegates who wish to
visit the hospital.
REMARKABLE WORK OF AMERICAN RED CROSS
Extent of Hospital Facilities — Testimony of Henry P.
Davison to Red Cross Volunteer Work
The hospital facilities for our army are necessarily
enormous, and innumerable emergencies inevitably arise,
according to a statement by Henry P. Davison in the
Red Cross Bulletin. He says:
"We have warehouses throughout France and Italy with
an extensive automobile transportation system, making
it possible to place supplies on short notice. Our whole
service was subjected to extraordinary demands during
the recent German drive.
"In France, we maintain thirty-seven warehouses for
the reception and distribution of goods. The daily receipt
of merchandise is sometimes as much as one hundred tons.
In one warehouse there are seven thousand tons of pro-
visions. We have upwards of seven million dollars' worth
of goods in our warehouses. When these goods are needed
their value is above price.
"Up to the time I left, our Red Cross had either dis-
tributed, or held available for immediate distribution,
more than twenty-two million surgical dressings and
bandages.
"We are operating a hospital supply system for 4,361
hospitals in 1509 cities in France. Their needs range from
safety pins to complete radiographic installations, and
have actually included oxen to plough fields and cows to
give milk for use in tuberculosis hospitals.
"Since July 1, 1917, we have supplied hospitals in
France with 3.375,000 separate articles. In Italy we are
sending supplies to 465 hospitals. We are operating 99
ambulances along the Italian front, driven by 129 Ame-
rican boys.
"We are serving both the French and the American
soldiers right up behind the lines with rolling canteens,
and also providing rest stations and canteens at railroad
stations.
"In fourteen milling canteens at the French front
3,240,000 hot drinks have been served to French soldiers.
At eleven canteens on the French lines of communication
we have supplied 3,913,000 meals. In fourteen canteens
in the Paris district in France we have supplied 4,251,277
soldiers with food and drink. Our activities among the
soldiers at the front in Italy are on a corresponding scale.
"We have established a factory to make artificial limbs
according to the best American practice and have dis-
tributed more than a thousand artificial legs and arms to
mutilated French soldiers. Five splint factories are oper-
ating under our supervision, making 15,000 splints and
accessories a month for the United States army hospitals
and supply depots.
"Our Home Communication Service has just been fully
organized. It searches for American soldiers in all the
hospitals, writes letters for them, and to any man, sick
or well, offers home help in whatever form it may be
needed.
"This service also searches for missing men, and locates
prisoners. It marks the graves of the soldiers who die.
This service acts as the line of communication between the i
American boys in France and the families and friends at
home. It helps them to get information about each other.
"The American Red Cross is itself operating thirteen
hospitals in France, two in Italy, and five in England. We
are also operating a large number of dispensaries in
France, England and among the Belgians. . . .
"Our activities extend from Scotland to Sicily, and a
very large part of the work is being done by American
volunteers. We also have important work still going on
among the refugees in Macedonia."
::^?:::^^oy'j^^^;^jjc^y^;oaa
THE MODERN HOSPITAL
A Monthly Journal Devoted to the Bmlding, Egittpment, and
Administration of Hospitals, Sanatorinnis, and Allied Institutions,
and to Their Medical, Surgical and Nursing Services
Vol. XI
October, 1918
No. 4
m;Mj^^(iKWWS^msm3[M^KWfrwM:^:MK.
THE EDWARD L. TRUDEAU INSTITUTION IN FRANCE
A Worthy Memorial to a Great American and Beloved Physician of French Descent A
Center of Education as Well as of Healing
By WM. CHARLES WHITE, M.D., Recently Chief, Bureau for the Care and Prevention of Tuberculosis,
American Red Cross in France
"W
ITH our friends the Americans, he was a
figure almost legendary, comparable with
Laennec or Pasteur. He merited a book. Edward
L. Trudeau is within his right in history. His
name will pass to posterity as that of a great cru-
sader. The world will guard the memory of this
generous founder of popular sanatoriums in
America, of this philosopher-doctor, this courage-
ous philanthropist, who had the good fortune to
concentrate his intelli-
gence and assistance on
the defense of those suf-
fering from tuberculo-
sis." Thus in 1916 wrote
Professor Maurice Le-
tulle of America's be-
loved physician, who was
of French parentage but
born in America, and
who was one of her most
priceless possessions.
Our part in the strug-
gle when the American
Red Cross came to
France in the summer of
1917 was to assist in the fight against tuberculosis
— a fight serious at any time but thrust into
prominence in all countries by a war which pro-
duced food-shortage, overwork, congested hous-
ing, severe prolonged sti-ain and new, unnatural
conditions for large groups of the population.
In France, the great battle-ground, as she has
been for ages in the world struggle for freedom,
conditions naturally were most severe. Besides
■. 1- One of the chateaux, s
region, which have been taken
Institution in France for use :
her own normal population, she was traversed by
all the allied armies passing to and from the war
zone — British, Americans. Italians, Belgians,
Portuguese, Serbians, and Africans, as well as
her own wonderful troops — and in those depart-
ments outside the war zone she was the haven of
all who were displaced by the war, refugees be-
fore the German advance, repatriates from be-
hind the central lines, Belgians, Serbians, and
many others in small
groups. In all of these
there would have been
enough tuberculosis at
any time to occupy a
great force of people; it
was multiplied by the
conditions of war.
France was awake to
the demand and coping
with it in the same spirit
with which she has met
all that has been forced
upon her, but there was
also great need for our
help and she accepted it
with the generosity which has spelled the heart
and minds of her leaders. We were not needed
to show her the way. Was she not the home of
Laennec, who taught us how to detect disease in
lungs, of Villemin, whose name stands preemi-
nent in all the foundation knowledge of the tu-
bercle bacillus, and of Calmette, the father of the
dispensary, the greatest implement of all in the
modern warfare against tuberculosis? Was she
ituated in a beautiful woodland
over by the Edward L, Trudeau
IS a tuberculosis sanatorium.
248
THE MODERN HOSPITAL
not a country with model sanatoriums at Bligny,
Berck, Hauteville, and many other places, and
with dispensaries and nursing schools springing
up everywhere? Had she not Letulle, Besancon,
Guinard, Kuss, Rist, Bernard, and Courment
leading the way? Any who thought of teaching
Fig. 2. A vista .iiiwn the beautiful woodland park surrounding the
buildings of the institution.
soon found that we were needed not for that, but
rather to help in the great burdens arising from
the emergency which crowded her own popula-
tion into one quarter and all the allied armies into
the other three quarters of her territory.
The most urgent need was help for her tuber-
culous civil population, refugees and repatriates,
dislocated homeless, and transient and broken
families.
Early in the autumn of 1917 the first oppor-
tunity for independent work came. Prior to that
time we had given assistance to French hospitals
and organizations already organized for the task.
But in October members of the English Mission
of the Society of Friends asked us if we would
undertake to reconstruct and operate a property
near Paris which had been offered to them by
the Department of the Interior for the care of
tuberculous refugees. This property lies in two
sections about a mile apart, covering about a
hundred acres, with three large buildings and a
number of typical French outbuildings. It had
been purchased before the war by the Depart-
ment of the Seine to fulfill a plan for a garden
city of which Mr. Henri Lucien was the orig-
inator. It is only twelve miles from Paris, easily
accessible by train or automobile.
Conferences were at once begun with the De-
partment of the Seine, the Department of the
Interior and the English Friends ; and the whole
property was turned over, rent-free, to the Amer-
ican Red Cross for the duration of the war and
six months thereafter.
By the middle of November conferences and
plans were completed and a group of American
Friends began the work of cleaning, papering,
plumbing and equipping. On Christmas day,
1917, six weeks after the work was begun, the
first three tuberculous refugees were admitted in
the midst of the confusion of work still under
way.
Through the generosity of private owners, it
became possible in the following months to secure
two additional chateaux in the immediate neigh-
borhood on the same terms as those granted us
by the Department of the Seine. After obtaining
the permission of the owners for all changes made
Fig. 3. A group of
alescents enjoying the open
in the buildings the American Red Cross agreed
to pay for them and for the current taxes and
insurance.
We decided to use these five large buildings and
the adjoining land for the tuberculous refugees
and repatriates, chiefly women and children and
their families.
The largest of the buildings, known as the
Chateau Hachette, was turned into a hospital
of eighty beds for women with active tubercu-
losis. The next in size, called the Sertillange
Home, was converted into a hospital for eighty
children. The third, just across the road, was
THE MODERN HOSPITAL
249
made a receiving ward of forty beds into which
all children were taken for two weeks' isolation
before entering the hospital proper to protect the
other groups against infectious diseases. Follow-
ing this, the orangerie of the Hachette house was
converted into a ward for twenty-five tuberculous
women, and finally this whole group was aug-
mented by wooden barracks to take care of
twenty-five children of tuberculous families; in
all, 475 beds. To these were added other barracks
for dining rooms, kitchen, school and play rooms.
In all of France one could not have found a
more pleasing or beautiful spot into which to
receive the unfortunate sick driven fi'om their
homes by an invading army. All the buildings
are grouped around a woodland park of many
acres with wonderful vistas and walks in which
the children are allowed to play, and on the ter-
si.xty acres of land, and opened our "school for
housing." In planning Malabry we aimed to meet
an emergency and at the same time to create
an organization which would be of subsequent
races and slopes are ideal places for those who
need rest, fresh air, and sunshine.
Not all has been quiet, however. For many
nights the patients were reminded of the fi'ight-
ful region from which they had fled, as the many
Gothas dropped their bombs on Paris or the long-
range cannon threw its shells in the direction in
which the new hospital lay. At such times our
American doctors and nurses were roused to
carry the sick and fearful into the cellars of the
old chateau and to quiet the fears of those in
whom the bursting bombs aroused such horrible
memories. Again, in spite of all its beauty, sad-
ness crept over the scene only too often. When
Major Murphy first came to see it and the patients
asked the privilege of singing the Marseillaise, it
took some blinking to hide the tears.
This group of 4.50 beds did not begin to satisfy
the demands that came to us. There was still,
as everywhere, the homeless in refuge that would
not separate from its sick. All were full of the
hope of returning to their former homes when
the devastation had ceased. To provide for these
we took the Malabry estate, two chateaux and
value in the reconstruction era. Each houseless
refugee family with a consumptive member is
given a small wooden house fitted out anew ; the
whole family, well or sick, will be under constant
medical supervision, and when the war ends the
family will be sent back, house equipment and all,
to the village of its choice, with the new and price-
less knowledge of how to live with a tuberculous
member in the household, to care for him and
to protect the others. They will be taught new
trades, if necessary ; the children will be taught
by the teachers of the French department of edu-
cation in open air schools. We are to begin with
a colony for two hundred houses, approximately
one thousand persons, with schools, workshops,
stores and a chapel. Each household will become
a center of education in the village to which it
returns. We have learned lessons from the hous-
ing of vast armies in the field under healthy con-
ditions, and it is hoped that through this demon-
stration the possibilities of simple installations
will be established for our whole tuberculosis
campaign.
To this entire group of activities, caring for
fifteen hundred refugees in which tuberculosis is
a common factor, we gave the name of Edward
L. Trudeau, Frenchman by origin, American by
birth, who gave forty years of his life to the fight
against the disease. His name honors both the
American and French nations, as well as this new
institution, and helps to draw the two republics
together in another common battle. We only
would that we could honor him more.
250
THE MODERN HOSPITAL
HOSPITALS CAN SAVE FUEL IN MANY WAYS
Two Classes of Hospital Heating Plants— Rules to Be Patriotically and Carefully
Observed in Heating Lar^e and Small Institutions — Maximum
Efficiency Possible with Lessened Tonnage
Prepared for the Modern Hospital by the United States Fuel Administration, Washington, D. C.
DEATH and destruction there must be on the
battlefield in spite of the supreme efforts of
doctors and nurses, but on this side of the Atlan-
tic death and illness are more readily controlled.
Now as never before it
is our duty to make our
death rate low.
Those in charge of the
heating plants of hospi-
tals are hearing the call
of the nation's fuel army
and are bending every
effort to save coal. For
them a double duty to
humanity awaits. They
must guard the lives of
those entrusted to their
care, and they must save
fuel to preserve those
who are fighting for
their country's life.
Hospital heating
plants divide themselves
into two classes. The
small hospitals are heated
by regular house-heating
plants, and the others by
large power plants. The
Bureau of Conservation
has ruled that all steam plants operating on 15
pounds' gauge pressure, or under, when not over
150 total boiler rated horse power, will come
under house-heating plant rules. All others will
be considered power plants.
A few rules should be patriotically and care-
fully observed by all who have the heating of any
building, large or small, as their special task.
1. Storm windows and storm doors, weather-strips,
and other protective devices should be provided.
2. It is wasteful to allow the temperature of a room
to go too low at night because a great deal of fuel is
required to raise it in the morning.
3. Use your thermometer and regulate the heat. Much
coil can be wasted by guessing at temperatures.
4. Know your heating plant and regulate it thought-
fully.
5. Keep your heating plant absolutely clean.
IF YOUR HOSPITAL IS SMALL
If the hospital in your chai'ge is small, the rules
TO SAVE OUR SOLDIERS.
Our war is a war of steel. The army
that can amass vast quantities of shells
and guns is the army that will make the
Great Drive which will win the war.
Unless we amass these products of
war in vaster quantities than Germany
can amass them, we shall hurl our sol-
diers to destruction.
But steel waits upon coal. Not a ton
of raw steel can be made and transported
without five tons of coal.
The nation hears the bugle note that
calls the coal army into action. Miners
have answered to the reveille. Railroads
have responded to its summons. The
coal conservationists in homes and indus-
tries must likewise hear it.
Will our hospitals, always agents of
mercy, add to their great service by sav-
ing coal to produce more steel and thus
reduce the list of casualties?
applicable to house-heating plants are the ones
for you to know and follow. Perhaps you know
many of them already, but the few you have
missed may stand between you and the saving of
a ton of coal.
There are a few gen-
eral rules which apply to
the operation of hot-air,
steam, or hot-water
plants :
1. Be sure there is a
check-draft damper in the
smoke-pipe besides the turn-
damper. This check-draft
damper is important in con-
trolling the rate at which the
fli'e burns. Open it to check
the fire. Close it to make the
fire burn more rapidly.
2. The turn damper
should fit the smoke-pipe
closely and must never be
entirely closed.
3. If you are using soft
or bituminous coal, make use
of the lift or slide damper in
the coaling door only to let
oxygen in to consume gases,
after fresh coal has been
added.
4 Just enough draft and
that from below, checking the
draft by letting more air into the smoke-pipe, is a good
general rule. This furnishes oxygen from below to con-
sume the coal gases, and gives time for them to be con-
sumed before being drawn up the chimney.
5. All heat pipes in the cellar should be thoroughly
wrapped with asbestos or similar covering.
6. Grates should be cared for properly. A short,
quick stroke of the shaker handle will sift the ashes
thi-ough the grates. Leave grates in flat position when
through shaking.
7. Avoid poking and slicing the fire-bed. It causes
draft holes and clinkers.
8. Never shake a fire that is low unless you have
put on a little fresh coal and given it time to ignite.
If you operate a hot-air furnace there are a few
specific facts about hot-air heating which you
should keep ever in mind.
1. Provide cold-air drops from upper floors so as to
insure a return circulation from all rooms to the air
intake of the furnace.
2. Regulate the window of the cold-air box so as to
avoid too great a current of outside air, especially on
very cold days.
THE MODERN HOSPITAL
251
3. Always keep the water container in the air-jacket
filled with clean water. Moist air heats much more
readily than dry air.
4. It is advisable to keep a jar of water near one of
the first-floor registers that sends out the moist heat.
5. Hot-air pipes should have a good pitch upward from
the furnace, and should be of sufficient diameter. They
should also be covered with asbestos.
6. Be sure the fire-box is gas-tight. All cracks must
be thoroughly cemented or a new section put in before
winter.
Steam heaters require a separate set of specific
rules in addition to the general ones in order that
they may be rightly operated.
1. The water in the boiler should be completely
changed at least as often as every spring and every
autumn. Draw a bucketful of dirty water from the
bottom at least twice a week and replenish it with fresh
water.
2. Look at the glass water-gauge whenever you attend
to the fire. Turn the exhaust-cocks above and below the
gauge occasionally to make sure that it is not clogged
or the openings to it from the boiler closed up.
3. The level of the top of the water must always show
at some point along the gauge. Its height will vary with
the temperature of the water. If it rises above the top
of the glass there is too much water in the boiler and
some must be dravm off; if it sinks below the bottom more
water must be let in.
4. Be sure that the exhaust valve of each radiator
works. Sometimes these valves need cleaning with a pin
or soaking in kerosene. They must be kept clean.
For the operation of hot-water heating plants
still other rules must be observed.
1. All the water should be emptied from the plant
and clean water put in at least as often as every spring
and autumn.
2. When the first fire of the season is built, as the
water gets heated, take the radiator key and open up the
exhaust valve of each radiator in turn until all the air
remaining in each radiator is allowed to escape. Make
sure there is no air to interfere with the free circulation
of the water.
3. Always be sure the water shows in the glass gauge
of the exhaust tank, which is usually located in the top
story of the house above the level of all radiators.
FOR HOSPITALS WITH LARGE HEATING PLANTS
If the hospital over which you have supervision
has a heating plant which according to rules
comes under power plant regulations, this set of
recommendations should be posted where your
firemen will see them frequently :
1. Keep a daily record of coal consumption, recording
such weights in the boiler room. A low rate of combus-
tion per square foot of grate surface means waste. The
coal burned per hour, divided by the grate surface in
active use, will give the pounds of coal per square foot
of grate surface per hour. For hand fire furnaces with
soft coal this figure should not be less than 15 to 20.
2. Keep daily records of feed water consumption.
This, with the coal record, permits calculation of water
evaporated per pound of coal. Use exhaust steam for
heating feed water. Steady or regulated feed of water
is a source of economy.
3. Determine the air pressure to the furnace with
draught gauges, connected to the furnace or breeching.
It eliminates guesswork and insures a proper supply for
combustion. Regulate the draft on the boilers with main
flue damper, after setting individual dampers on each.
4. Tubes should be frequently and thoroughly cleaned
and feed water properly treated to prevent scale formation
on the inside of the boiler or tubes.
5. Grates should be in good repair, and setting, breech-
ings, and access dooi-s should be free from air leakage.
Surfaces wasting heat should be covered with insulation
of ample thickness.
6. Steam piping, drums, and feed-water heaters should
be properly covered with insulating material.
7. Some special person should be designated to look
after fuel conservation in the entire building and heating
plant. In this way many economies may be accomplished
that would otherwise be overlooked.
DO NOT OVERHEAT ANY ROOM
The doctors and nurses will know just what
temperature their various patients need. Be sure
no room is overheated.
According to Dr. Ellsworth Huntington of Yale
University, a varied temperature, averaging from
60 to 64 F., is best under ordinary circumstances
for the human race. Every living thing has a
temperature at which it can do its best and above
or below this there will be trouble. Moist air is
more healthful than dry, provided it is not too
warm, so it is necessary for the heating plant
operator to see that the air in each room has
enough humidity. It is advisable to keep a jar of
water in heated rooms so that the air may absorb
moisture from the water instead of the body.
Use all thought to save every pound, every
ounce of fuel possible by operating the hospital
heating plant with maximum efficiency. Every
agency in the United States is enlisted in the army
to save fuel, the foundation of all war activities.
Hospitals have their share in the fight to provide
more coal for war needs.
The Quarantine Stations at Didam, Sittard and Venloo
Great wars are always accompanied by epidemics of
infectious diseases. During 1916 and 1917 several epi-
demics of smallpox and typhus fever broke out in various
parts of Germany. As numerous deserters and escaped
prisoners of war entered Holland from the eastern frontier,
the Dutch government was compelled to erect special
quarantine stations to protect the health of its people.
For economical reasons it was decided to erect three large
stations instead of numerous small ones. Each station
consists of a disinfection building, a hospital with a num-
ber of divisions for the various infectious diseases, includ-
ing sexual and skin affections, a building for the military
force, a house for examining deserters, offices, storerooms,
etc. As the incubation period of the various infectious
diseases differs very much the average duration of obser-
vation, to which all quarantined persons are subjected, is
twelve days. R. N. Eykel describes these stations in a
number of the Ziekenhuis.
Cheerful; ess is the daughter of employment, and I
have known a man to come home in high spirits from a
funeral merely because he had the management of it. —
Dr. Home.
252 THE MODERN HOSPITAL
THE HOSPITAL OF EXTENDED GRACE TO WOMEN AND CHILDREN
Strange Customs Reflected in Hospital Life and Construction— Warm Floor Method of
Heating Successful and Economical— Success of Korean Women
Physicians and Trained Nurses
By MRS. ROSETTA SHERWOOD HALL, M.D., Harris Hospital, East Gate, Seoul, Korea.
WHAT would The Modern Hospital think of a
dispensary waiting room without seats, and
of hospital wards without beds? Such was our
style always in the early days in Korea, and a
number of our more "modern" hospitals continue
this plan for our Korean patients. And why
should they not ? We western physicians came to
i
M
i
1
r
I
K\m
M
■H
this land following the example of the Great
Physician, whose precept is, "Heal the sick and
say unto them, 'the kingdom of God has come
nigh unto you.' " Now, Dr. Barton has said to us,
"Don't go to the East to change customs that are
indifferent." There are some customs in Korea
that are not only indifferent, but are safer than
the Western customs — for instance, the wearing
of white clothes. This has been adopted by doc-
tors, nurses, and street-cleaners the world over.
Another time I may tell you more about this and
other good features of Korean dress and customs.
The poorest Korean home contains two rooms
— usually three — the kitchen, a room for the
female members, and one for the male members
of the family. If there be but two rooms in the
house, the one is shared in common, as sleeping-
room, dining-room, and living-room ; but if there
be the "inside" room for the women, and "out-
side" room for the men, then the tables of food
from the kitchen are each sent to their respective
departments, and there is no common living room.
Since Koreans sit, eat, and sleep on the floor, with
Fig. 3. Graduate nurse and two little patients with co.xalgia in plaster-
of-paris splints. The nurse first entered the hospital as a patient,
having had the end of her nose cut off by a jealous husband.
but one living room, they are far more comfort-
able, strictly speaking, than a Western family be-
cause this room is so easily transformed into a
.sleeping room, dining room, or parlor as needed.
There is neither stove nor hot-air register to
cause dust or dirt, and no room is taken up by
steam or hot-water radiators, which also are apt
to collect more or less dust and dirt. The entire
floor is comfortably and most economically
warmed by the same fire that cooks the food and
heats the water for the familv.
THE MODERN HOSPITAL
253
In the kitchen, with its floor of earth, the rice
kettles are built in with tile and mortar at the
side adjoining the living room, and the flues
spread out under the entire living room; in short,
the floor of the living room consists of these flues,
or prostrate chimneys which converge into one
outside chimney at the opposite end of the room.
Since the blaze and sparks of fire are exhausted
during their passage through this floor of stone
and mortar, the outside chimney need not be high
or fire-proof. Even in straw-thatched houses the
chimney consists often of but a roll of matting or
a hollow log projecting but slightly above the roof.
Fig. i.
Korean mother, twin babies and older daughter
Margaret" childreii's ward.
The Koreans make the strongest and best paper
in the world, and have a method of oiling it and
making several plies into one. They cover their
best floors with this paper, which, because of con-
stant use, takes on a polish like marble. Because
the Korean sits, eats, and sleeps on these warm
floors, he follows the good custom of leaving his
shoes outside the door, preventing the germs of
the street from being carried into the room ; and
the polished floors are not defaced by the nail-
prints of shoes, though dust-catching carpets or
rugs are not used.
Lest I convey the mistaken idea that Korean
homes are all patterns of cleanliness, I must ex-
plain that only the higher class or the well-to-do
use the oiled paper covering; the others practice
customs that seem very far-fetched to us. They
use only reed mats over the mud and stone floor,
and conveniently turn them up to spit under; and
they even allow their babies' urine to run through
and dry in the warm floor beneath. But their cus-
toms are ideal in families knowing the principles
n babies at the Harris
of cleanliness, strange though they may seem at
first.
This method of heating by warm floors is pe-
culiar to Korea, and though there is a hint of it
in the Russian stove amid-walls, and in the
Chinese kang, it seems that the Korean method
excels by far in economy of fuel and space, and in
so much as it keeps the germs of the street from
being carried into the home.
The Japanese have no method of heating their
rooms, save by a brazier which exhausts the oxy-
gen and often adds carbon dioxide to the air.
These people are progressive, being especially
quick to adopt and adapt the best of every land ;
and in Korea, in their newer and better homes
and hospital wards, they also use the Korean
warm floors.
You may note that the Woman's Hospital of
Extended Grace in Pyeng Yang appears in the
s. 6. Forty-year-old father taking home hii
twins born at the Harris Hospital, Seoul, i
or carrying chair.
254
picture to be much like any other Western build-
ing, but it is quite different in its interior ar-
rangement.
Koreans, having had the comfort and even
luxurv of these warm floors for generations, suf-
fer great hardship, even though they are well and
strong, when they have to sleep
in cold beds. Children, old
people, and the sick most of all,
suffer very much. They often
develop enteritis or pneumonia
when they enter the foreign-
bed hospital for some other
trouble; and some have died
when far worse cases have re-
covered in a hospital that has
adopted the warm floors. A
tuberculosis patient in a pri-
vate room having these warm
floors and keeping its windows
wide open feels perfectly com-
fortable and happy the coldest
weather. Delicate creeping
babies improve so upon these
floors! And after a tedious
operation or a collapse, what
could be better?
This arrangement is per-
fectly safe; the patient cannot
get out of bed without the
doctor's permission. There is
no need of hot-water bottles; these prove a
nuisance, as they burn, break, or spill ; there have
been cases where tiny American babies have been
drowned by them.
The floor is quite sanitary. The smooth oiled-
paper covering is wiped up with an antiseptic
THE MODERN HOSPITAL
solution as often as is necessary. By this means
vermin, which so often infest beds in spite of the
best care, can be kept away.
Then, a mission hospital is economical. There
is practically no cost for beds and extra fuel. We
also adopted the Korean plan of taking closet
room from the upper part of the kitchen over the
space reserved for the rice kettles. This, opening
from the ward, makes a place, without taking up
other room, to fold up the mattress and bedding
used by convalescent or walking patients. By
this means their part of the ward is easily trans-
formed into a sitting room, or a dining room,
when the individual Korean tables are brought in.
But to build a hospital in this way, the warm
floor ward must be upon the ground floor ; and, for
economy, the dispensary, operating room, Amer-
ican doctor's rooms, and private rooms for
American, European, and Japanese patients, upon
the second floor. The tall brick chimney in such
a building makes too great a draft for the fires
in the Korean kitchen, and have to have dampers
built in them. The Korean patients are practic-
ally all cared for on the lower floor, and there-
fore neither they nor their nurses have much
climbing of stairways. Though the foreign
doctor may have to strain her back and knees in
order to count pulse, make physical diagnosis,
attend to obstetrical cases, and do surgical dress-
ings with the patients lying on the floor, the cus-
tom has its advantages, as pointed out above.
Abnormal obstetrical cases we deliver on the
THE MODERN HOSPITAL
255
table, and any other difficult case can, of course,
be lifted there at any time. Our Korean nurses,
having been themselves brought up on the floor,
find it no hardship to care for the patients this
way ; and now with the advent of Korean women
doctors, the hardships foreign doctors have en-
dured will largely pass away.
Fig, 9. Ouv lirst deaf-mute pupil on her wedding day, showing the
"hams," or brass-bound boxes containing the wedding
Visitors always exclaim over the beautifully
polished floors of our large waiting room and the
rooms where the westerner seldom enters. Since
our Korean patients only walk about in their
stocking feet and seat themselves upon the floor,
they keep it polished without any effort on our
part.
One question that may arise within the inquir-
ing mind is that of ventilation. I will say that
this seems to be quite the reverse of ours. For-
tunately, the windows can be kept open during
the greater part of the year. In severe weather,
when they must be closed, we note, when we enter
a room heated by the Korean method only, that
the upper air is cold, and one is not quite com-
fortable unless he is sitting or lying on the floor
where the heated air is. Therefore in the hos-
pital referred to we arranged for the fresh air to
enter about on a level with the patients, and the
foul air to escape at the ceiling. At any rate, ven-
tilation is adequate.
The Korean habit of sitting comfortably in a
squatting posture on the floor makes possible an-
other sanitary custom — that of building privies
without seats. And in our hospital we follow the
Oriental custom, having no seat, although the
arrangement is of porcelain, level with the floor,
having water flushings after our western fashion.
In-patients, dispensary patients, and out-calls,
inclusive, number five thousand to seven thousand
annually, to the average of one foreign doctor
with native helpers largely trained by herself.
Now that we are beginning to
secure graduate Korean nurses
from our nurses' training
school at Harris Hospital, East
Gate, Seoul, and to engage Ko-
rean women physicians trained
at the Medical College and
Hospital of the Chosen Govern-
ment General, we can, no doubt,
do a far greater work.
During my twenty-eight
years in Korea there has been
a gi-eat change taking place
slowly but surely concerning
the kind of diseases and the
character of patients frequent-
ing our women's hospitals.
Formerly only low-class women
came, high-class women not be-
ing allowed to go upon the
street except in closed palan-
quin, and then largely for sur-
gical relief; later, however,
brides dress and the j-j^gy fouud that we could treat
eye, ear, and skin troubles bet-
ter than the native doctor. It took a long time
for them to believe our drugs were superior for
internal medicine, or that the western physician
could understand the inside anatomy of a Korean ;
however, from the first, we were called to the
Fig. 10. Dr. Ha
the Hospital of E.xtended
256
THE MODERN HOSPITAL
homes of the high and the low for obstetrics.
Gj-necological cases were so rare that it almost
made us believe that Korean women did not suffer
as much as others from so called "female com-
plaints." But within the last decade the change
has been marked. Women of the middle and
higher classes now come freely to our women's
hospitals and dispensaries ; even wives of officials
await their turn with the low-class women. And
we find all the varieties of g>'necological troubles
of the homeland, and, owing to the results of the
native forms of treatment, we see some variations
that our professors never saw.
Last year, according to the record book, the
diseases classified and in their numerical order
were gynecological and obstetrical, medical, sur-
gical, skin, eye, ear, nose, and throat. One-third
of all new cases and one-half of the return cases
were gynecological.
I was much pleased to read, in a recent number
of The Modern Hospital, of some hospitals in
Japan, and to see their pictures. I myself have
visited the Red Cross Hospital in Tokyo, and can
say that the very sane treatment described by Dr.
Ishida for the insane patients of the Nagasaki
Hospital certainly appeals to me.
As to equipment and general management of
our hospitals for Korean women, perhaps I can
not do better than to quote from a letter signed
by Mr. T. Sekiya, director of Bureau of Education
in Chosen. Mr. Sekiya has traveled in both the
United States and Europe. He writes under date
of March 2, 1918, as follows:
"Dear Doctor Hall: It was with great pleasure and
admiration that I observed recently how your hospital is
being carried on. It is well equipped, and is so clean and
so comfortable! It gave me a most pleasant impression
of your Korean nurses. They are as well trained as the
foreign nurses, and they tend patients with warm kind-
ness and affection. I can well fancy how great the favor
of your hospital is and how grateful the Koreans are for
it. I am sending you with this note some apples from
Taiku which I request your acceptance of, hoping that
you will taste them with your nurses."
HOW AMERICA MAY HELP BELGIUM AFTER THE WAR
A Message to This Country from a Member of the Belgium Mission on Industrial Man-
agement— A Permanent American Foundation in Belgium Suggested
to Foster the Brotherhood of the Two Nations
BV Captain Dr. RENe SAND, Lecturer in Social Medicine, University of Brussels,
Belgian Mission on Industrial Management
Member of the
NO one fails to see the obstacles which will
stand in the way of reconstructing our in-
dustrial and economic life after the war. Three-
quarters of a million Belgians are either with the
army, or working in free Belgium, in France, in
Holland, in England.
Seven million still remain in the invaded part
of our country. American generosity and effi-
ciency— although beyond praise — are unable to
prevent their rations from being scanty. Tuber-
culosis is rampant. The children are arrested in
their physical development. Infant mortality,
owing to the shortage of milk, is exceedingly
high. The birth rate has fallen to a fraction of
the death rate. More than a hundred and twenty
thousand men — one out of every fifteen adult
males — have been deported to Germany ; they are
now either dead or permanently broken down.
To work would be to aid the German army ; so
the industrial population has remained idle for
four years. The inhabitants have small gardens,
on which they grow potatoes and vegetables. But
their health is gone, their skill is gone, their habit
of speedy teamwork is gone. The factories have
been purposely destroyed, the machines sent to
Germany ; railways and roads will be left demor-
alized and wrecked.
The spirit is unbroken, and nothing will shake
it. A nation which has during ten centuries re-
volted against foreign domination is not likely to
be subdued in a few years. But with the coming
of peace new difficulties will arise.
It is easy to remain united in a defensive war.
Differences will arise as soon as reconstruction
begins. It will be impossible to avoid altogether
party prejudices, religious discussions, differ-
ences of language, conflicts of interests and of
ideals.
Another danger lies in the intellectual isolation
to which the Belgians have been subjected. They
have scorned German books and periodicals, but
no other literature is available for them. Like
the handw'orkers, the brainworkers have patri-
otically chosen to remain idle, so far as the
assimilation of new facts is concerned. Occupied
Belgium has to live on itself and by itself. How-
ever, for reconstruction work, a wide outlook and
an up-to-date knowledge are necessary. And will
there not be, after such a restricted, compressed
e.xistence, an immense desire for relaxation, for
self-indulgence, at the precise time when a stern
spirit and a steady purpose will be needed ?
Nothing is as tragic as a lost opportunity.
Belgium will have a fresh start after the war;
THE MODERN HOSPITAL
257
she will have a chance to rebuild not only her
villages and factories, but also the whole of her
political, educational, civic and social life. This
is such a rare event in the history of a nation
that to let it pass unused or only half used would
be a greater calamity than the war itself.
The first few months of peace will decide our
future fate ; either we shall slip down to haphaz-
ard ways and hasty patched-up solutions, or we
shall rise to a system of competence, efficiency,
and constructive reform. At that moment our
convalescent nation will need material help, per-
sonal help — nurses, social workers — and advice.
Infant mortality, bad housing, occupational
hazards, tuberculosis, alcohol, venereal diseases
will be among the most important problems. This
means a hard struggle against ignorance, vested
interests, old careless habits ; nothing short of a
great educational campaign will foster in a physi-
cally weakened and economically ruined nation
the strength required for such an immense eff'ort.
To give us a lead in these matters America is
especially well situated, as she possesses the
genius of organization together with far-reaching
views and generosity of purpose. Besides, the
assimilation of immigrants has made Americans
familiar with this kind of work. The American
Red Cross and the Rockefeller Foundation have
already helped France on similar lines with great-
est success, and the United States has become
so endeared to the Belgian people that every
American initiative is sure to be enthusiastically
and gratefully accepted.
We could imagine no greater service to our
country' and no better way of perpetuating the
brotherhood which has grown up between both
nations than a permanent American foundation
in Belgium. Its triple purpose would be to foster
research, to off'er information on reconstruc-
tion problems, and to maintain an educational
campaign aimed at raising the standards of life
in Belgium.
Nothing can be done now on these lines. The
war has to be won first. But it is perhaps not
premature to try to outline the work which will
have to be taken up as soon as hostilities will
stop, and which would come too late if it were to
be planned and discussed after the conclusion of
peace only. We were unprepared for war; let us
be prepared for peace.
A CANADIAN CIVIL HOSPITAL'S PART IN WAR WORK
Response of Vancouver General Hospital to Request of Military Hospitals Commission —
Military Annex and Its Equipment a Gift From Citizens of the City and Province
By MALCOLM T. MacEACHERN, M.D., CM., General Superintende.nt, Vancouver General Hospital,
Vancouver, B. C.
SINCE war commenced many civil hospitals
have altered their policy and line of e.xtension
and development, owing to the war, and e.xtended
their service along war lines and demands. One
of the Canadian hospitals which has participated
in the care of soldiers from the outset to the
present is the Vancouver General Hospital, a well-
established, well-organized, and well-equipped in-
stitution.
In the first year of the war this hospital opened
its doors to recruits and many hundreds were
fixed up for active service at the front. Shortly
after this came the enlisted soldier, and for a long
time a great number were treated in the wards
of the hospital, where they were given use of all
the civilian facilities, but kept mostly in a sepa-
rate section of the hospital. Two years ago the
Military Hospitals Commission of Canada asked
the hospital to take care of three hundred re-
turned wounded or sick soldiers, many of them
cot cases. Previous to this the hospital had been
caring for a smaller number of returned men, but
it was felt that increased accommodation was
needed on account of the rapid evacuation of
Canadian soldiei's from all hospitals in England.
However, the request of the Military Hospitals
Commission was quickly complied with, and in the
course of three months, accommodation for three
hundred soldiers was arranged for in a comfort-
able and well-equipped annex to the Vancouver
General Hospital. The building and equipment
were a gift from the citizens of the city of Van-
couver and the province. The excellent equip-
ment was supplied through the efforts of the
women of the city; the money for the building
was raised by the business men. Both these or-
ganizations were very enthusiastic in their work,
and seventy to seventy-five thousand dollars was
raised in short order. The building was soon
erected, equipped, and ready for patients, and
since that time has been used constantly. This,
possibly, has been one of the most successful and
complete undertakings with which anyone could
have the privilege of being connected, and showed
distinctly the advantage of cooperative organiza-
tion. The business men organized themselves into
a financing committee and in a few days raised
the money ; the ladies of the city organized them-
258
THE MODERN HOSPITAL
selves into an auxiliary of about three hundred
members, and with a capable and representative
committee of management soon had the money for
the equipment raised and all in hand. Everything
Fig. 1. The military
of Vancouver General Hospital.
ment has always been a most harmonious one,
and, indeed, general satisfaction and efficiency
have been manifested.
The civil hospital finds that the military hos-
pital does not interfere at all with it in its work.
The extra staff needed was very simple. In the
various departments throughout the main hospital
a few e.xtra help had to be added here and there
and some additional equipment. The well-
organized and established facilities very soon
adapted themselves to the increase of two to three
hundred patients. The civil staff of the military
annex is as follows at present : Nurse in charge
or supervisor of the nursing of the entire institu-
tion; each ward has the following staff: ward
supervisor or graduate nurse, three or four ward
helpers or attendants, two orderlies, one cleaner.
The nurse in charge does all the medication or
was done according to well-laid-
down plans and standards, so that
on completion there was nothing
missing.
All equipment was of a standard
nature, so that it could be used for
further hospital purposes after the
war was over.
The location of the building is
about thirty feet from the end of
the service wing of the Vancouver
General Hospital. This meant easy
access to civilian facilities, such as
operating rooms, kitchens, x-ray,
laboratory, etc., and had an eco-
nomic adv^antage in saving expen-
diture of money in duplication of
facilities.
The arrangements of the Van-
couver General Hospital and the
military annex are rather unique,
inasmuch as the Vancouver
General Hospital supplies the
complete service, excepting the
medical officers and the military
officials needed for clerical work,
discipline, etc.
This annex is used for active
cases, whereas the splendid conva-
lescent hospitals of Vancouver are
close at hand and are under purely
militaiy management.
The hospital is, therefore, mostly
civil in administration, though the
medical officer resident is military,
and deals directly with the general
superintendent in matters arising
out of civil details. The arrange-
|t ■■■
V-ARD » 40BtDS '
A"ARD I* AO BEDS " ^f
WARD « 40 BCD^
VAMCOUVtC 6CNEEAL n05P(TAL
Fig. 2. Front elevation and floor plan of the Vancouver General Hospital military annex
for returned soldiers.
THE MODERN HOSPITAL
259
treatment, whei'eas the ward attendants or help-
ers do all the bedmaking, dusting, tidying, etc.,
as well as cari-ying and assisting with the serving
of meals. These are under direct supervision of
the nurse in charge, and are paid a small salary
for their services. They are not the so-called
V. A. Ds, as they are girls that are working to
a certain extent for the love of the work and con-
tent to take a living wage. This scheme has
proved exceptionally successful, inasmuch as the
general work of the ward is done very efficiently.
The orderlies do such work as is required of
them in the civil hospital. We have had several
military orderlies who are there for experience
and training.
In addition, there is also a relieving nurse be-
tween the wards on each floor. In each ward
there is a military officer known as the ward mas-
Fig. 3. A ward sitting room in the military annex.
ter or sergeant. So far as carrying on the work
is concerned, with the staff as outlined there has
been no difficulty.
By the accompanying plans it will be seen how
very simple the layout is, but yet efficient to do
the work. There are eight units, all having com-
plete and separate service, each unit capable of
caring for forty cases. This, we find, gives better
service in such a hospital. Then again, if this
building ceases to be used for military purposes,
it can become a useful adjunct to the civil hos-
pital, inasmuch as different units can be devoted
to different conditions.
The sanitary facilities are built out at the end
in each case, with plenty of circulation and air
roundabout. The nurse's office is so arranged
that she has complete view of her wai'd at all
times. In addition, there is a dressing room,
doctors' room, linen room, sitting room and
kitchen attached to each ward, making the unit
complete. Since the erection of the building an
Fig. 4. A view in the wards of the military annex.
extensive solarium has been attached to the front,
capable of holding a large number of beds at one
time. The upper story is connected with the serv-
ice wing of the civil hospital by a bridge, which
gives direct connection to the main kitchen, and
thus the food problem is readily handled.
Speaking from a civilian standpoint, there are
several advantages in the scheme as carried out.
First of all, it gives the returned wounded soldiers
the opportunity of using the up-to-date well-
established and well-organized facilities of the
civil hospital as well as the service of an experi-
enced staff, which it might take time to get under
other arrangements.
Secondly, it saves the country a large amount
of money by not having to duplicate facilities
such as operating rooms, x-ray laboratory,
kitchens and other costly facilities in hospital
construction.
Thirdly, the citizens of Vancouver and a great
many of the province have a more direct hand in
war work, inasmuch as they have given freely of
their funds and possibly a great many of them
helped with their hands to carry on this work,
giving each and all a more personal touch with
the war as it is today.
Lastly, we have given employment to a large
number of people who, though anxious to get over-
260
THE MODERN HOSPITAL
seas and do something at the front, are prevented
from doing so for good reasons. We have always
endeavored to take such people on our staff, for
we find that those people have their whole heart
in the work.
I am not going to speak for the military side
of it, but all that I have heard has been commend-
able. I will say that, so far as discipline is con-
cerned, from my observation I do not think that
there could be any better anywhere than we are
having.
Recently the Vancouver General Hospital has
taken on some more war work, inasmuch as an
arrangement has been made with the Invalided
Soldiers Commission of Canada to set aside a por-
tion of the hospital for the treatment and care of
the discharged returned soldiers who are being
brought back to civil life. This latter class will,
of course, gradually increase and finally be a large
number.
In conclusion I want to apologize for this very
shoi't, hasty and somewhat disconnected descrip-
tion of our arrangement with the military depart-
ment. The arrangements made here in the Van-
couver General Hospital may be somewhat unique
in themselves and somewhat more than have been
made with other civil hospitals in Canada, but still
I must conclude that so far they have been satis-
factory, and I feel that efficient and good results
have been obtained in all cases.
AN EFFICIENCY SYSTEM FOR THE MEDICAL WORK OF STATE HOSPITALS
Records That Are a "Second Memory" for Physicians — How the Clerk Can Help — Keep-
ing Tab on Regular Duties and Happenings— The Purpose of the System
By H. DOrGL.A.S SINGER, M.D., M.R.C.P., State Alienist, Department of Public Welfare, State of Illinois.
'^T^ HE work of the medical officer in a state hos-
-*- pital includes a very large proportion of
routine which is very likely to include much that
can be just as well performed by some non-pro-
fessional worker. There is a great tendency to the
occurrence of much waste of time, due to various
causes, such as looking up previous records, wait-
ing for a patient to be found for examination, fill-
ing in blanks, which is often a purely clerical pro-
cedure, being called away for visitors, etc. There
is also a very serious liability that patients who
stay in the institution for a long time will be over-
looked. The records of examination upon admis-
sion are, as a rule, fairly complete, although even
here omissions of some detail are not infrequent,
but the notes upon the progress of the case are
quite often sadly deficient.
In order to minimize the.se defects and relieve
the medical staff of the necessity for remember-
ing from day to day the routine duties to be per-
formed, an efficiency scheme has been introduced
into the Illinois state hospitals which has now
been in force in one for about eight months. The
system has been found to work very simply and
satisfactorily and to have resulted in a marked
improvement in the records and a great saving of
the physician's time. It will also provide an ob-
jective basis for the estimation of the physician's
efficiency, which will be valuable for determining
promotion, and will afford a clear index of the
size of the medical staff needed for the particular
hospital. This last feature is of very great value,
for this question has in the past been largely de-
cided by guess or custom. The size of the hos-
pital is no real criterion of the size of the staff,
and even the admission rate, which is a much
more important index, will not settle the answer
conclusively, as much will depend upon the type
of patients being received.
MINIMUM REQUIREMENTS FORMING BASIS OF
SYSTEM
The basis of the system is the establishment of
certain minimum requirements for studying pa-
tients and recording the results. Such require-
ments can be modified at any time without mate-
rially altering the system. Those which have been
adopted may be divided into two parts: (1) the
examination on admission; (2) examination sub-
sequent to this.
(1). Records upon admission. These must in-
clude the following points and must be completed
within the times set :
A. Initial examination, to be made within twenty-four
hours. This is a superficial survey of the physical
and mental condition, made with a view to obtaining
a record of obvious facts and determining the im-
mediate needs in the way of treatment or more exact
study.
B. Anamnesis, to be obtained as soon as possible. The
time required may depend upon the ability to secure
interviews with relatives and friends, and hence no
definite limit can be set. Check of the visits from
those capable of giving information is kept by the
efficiency clerk, who will notify the doctor concerned
when such opportunity occurs.
C. Physical examination, to be completed within three
days.
D. Dental examination, to be completed within three
days.
E. Urinalysis, to be made within three days.
THE MODERN HOSPITAL
261
F. Blood for Wassermann test, to be taken within
three days.
G. Vaccination, to be done within three days.
H. Mental examination, to be completed within seven
days.
I. Presentation at a staff meeting, to be made within
ten days.
J. Summary of all previous investigrations with, if nec-
essary, second presentation at a staff meeting-, to be
made in a period from three to six months. The de-
cision as to the necessity for second presentation is
made at the first staff meeting, and an approximate
date for this is set. It can be changed with the con-
sent of the officer responsible for the medical work
of the institution. A case may be recommended for
repi'esentation at any time by the physician in charge,
if he deems it desirable.
K. Special points for further study, requested during
the discussion at the staff meeting, with the time at
which they should be completed, will be noted at the
time of the staff meeting and will be indicated to the
efficiency clerk.
(2). Records subsequent to the first detailed
e.xamination (progress notes) . The more acute
cases require more frequent records. The fre-
quency' required as a minimum has been set as
follows :
A. Acute mental tcards, every seven days.
B. Acute bodily illness, every three days.
C. Subacute and convalescent cases, every thirty days.
D. Custodial cases, every six months.
The decision in which group a patient is to be
placed rests with the clinical director or the offi-
cer performing this function. To a large extent
this will correspond with the subdivision into
wards, but in some instances, especially on the
hospital for somatic diseases, there may be pa-
tients belonging in several categories, requiring
notes, for instance, every three, seven, or thirty
days. The rule is made that every patient sent to
the hospital ward is placed automatically in the
three-day group, and remains there until instruc-
tions to change this are issued.
METHOD OF KEEPING CHECK AND BLANKS USED.
1. Persomiel. — One clerk is capable of keep-
ing account of the examinations needed, and the
work done for a hospital with two thousand to
twenty-five hundred beds and having an average
admission rate.
2. Cards used. — A. Figure 1 illustrates the
front and back respectively of a card which is
made out for each patient. At the left, on the
face of the card, is printed a list of the routine
examination requirements. The clerk enters in
the adjacent columns the date when these were
filled, and by whom. Under the heading, "Special
Investigations," the clerk will write in any fur-
ther investigation requested either at the staflf
meeting or by other means, and the dates when
they are performed. At the extreme right are
columns for the ward on which the patient is liv-
ing, with the date on which he went there. The
clerk must be notified of all transfers, so that the
proper grouping of the card can be made. The
heading "group" above refers to the 3-day, 7-day,
30-day, or 180-day notes required for this patient.
On the reverse side space is provided for enter-
ing the dates on which medical or dental progress
examinations are made, and further space for
possible transfers.
These cards are filed under index cards as fol-
lows :
(i) The main headings are: Reception, 3-day, 7-day,
30-day and 6-months.
(ii) Subheadings: Under each of these main heads-
the names of the wards on which there are patients-
requiring examinations at these intervals,
(iii) The cards are filed alphabetically under the ward
names.
When a transfer is made, or the frequency of
examination is changed, the clerk must remove
the card from the group in which it is at the mo-
ment, enter upon it the name of the ward to which
the patient has been sent, with the date or the
new group in which he now belongs, and then re-
file under the new heading.
The clerk is also furnished with a list of the
wards under the charge of each physician with
the number of patients making up the service.
He thus knows how many patients in each group
must be examined by each physician, and divides
the number of the frequency with which records
are required. Thus, suppose a physician has on
his service three patients in the three-day group,
ten in the seven-day group and one hundred and
fifty in the thirty-day group. In order to com-
plete these, he must examine one of the first, one
or two of the second and five of the third each
day.
The names of the proper number are selected
by the clerk and placed upon the card of physi-
cian's duties which is handed to him in the morn-
ing immediately after staff" meeting.
B. Figure 2 shows above a copy of the physi-
cian's or dentist's duty card, and below that for
the person in charge of the laboratory. Both are
3 by 5 inches in size. The efficiency clerk writes
upon the physician's card the name and ward of
the patient to be examined, and indicates by the
following symbols the particular nature of the
examination to be made : A, anamnesis ; P, phys-
ical examination ; M, mental examination ; D,
dental examination ; S.M., to be presented at staff
meeting; Sum, summary; P. N., progress note;
C, correspondence; I. M., inspect meals; W. R.,
obtain blood for Wassermann reaction ; L. P., lum-
bar puncture ; Vac, vaccination. At the same
time he notifies the ward to have the patient in
readiness, and collects the records, if these are
262
THE MODERN HOSPITAL
not on the wards, and hands them to the physician
with the duty card.
The routine urine specimens are ordered sent to
the laboratory without the intervention of the
physician, and at the same time any other clin-
ical laboratory examinations which are required
are entered upon the card for the laboratory'.
The number of specimens only is entered on these
cards, which would otherwise have to be very
large. A typewritten list of the names and
wards of patients from whom specimens have
been ordered is sent to the laboratory with the
Fig. 1. Front and back of the individual card made out for each
patient. The original card measures 4 by 6 inches.
card. Similarly the person in charge of the labo-
ratory enters upon his card only the number of
specimens which have been examined, and re-
turns the list of names with a check against those
which have been done.
The physicians and dentist check upon the
cards the examinations which they make and re-
turn the cards at the end of the day to the effi-
ciency clerk, who enters the facts and date upon
the cards of the patients concerned (Fig. 1).
Should the physician perform any duty not en-
tered upon his card, he writes the details upon
the back of his card.
When a physician has charge of a service with
the assistance of one or more of junior rank, the
clerk makes out as many cards as there are med-
ical officers, all of them containing the complete
list of duties for the service. It is then the duty
of the physician in charge of the service to allot
the work for each of his assistants by crossing out
all other duties and to give one such card to each
assistant.
Duties not performed on any day will be added
to those for the next day.
3. Instructiojis concerning progress notes. —
The following set of instructions are given con-
cerning what must be contained in notes upon
progress :
A. Facts which would tend to clear up questions raised
at the staff meeting.
B. The condition of the patient at the time.
C. Any special happenings since last note (most of these
will be recorded automatically from the daily report
blanks, see Fig. 3).
D. Treatment which has been followed since last note.
This will include occupations, re-education, etc.
In the case of the custodial wards the semi-
annual notes must show :
A. The general physical condition of the patient as de-
termined by actual examination.
B. Urinalysis.
C. Features which might lead to a reconsideration of
the classification or of the opinions expressed as to
the possibility of release.
D. Facts indicating any special requirements for treat-
ment or dangers to be avoided not previously present
or not recognized.
ADDITIONAL FEATURES
1. Blanks. — In order to provide for notice to
the efficiency clerk of requests for special exam-
ination, transfers, etc., and at the same time to
keep the superintendent informed of important
happenings in the institution, the blank shown in
DI. SBVICI DATE
1
.'
'•'"'"■
, „„„m
BADE
DI
DATE
DI
i
Spiuinuid
BI«dCoa«t
---
-
---
-
Above, physician's or dentists' duty card : below, card for
pei-son in charge of the laboratory. Each measures 3 by 5
Figure 3, made up in pads, is carried by each
medical officer. Upon this blank the physician
enters, during his visits to the wards, anything
which may be of importance as to the condition
of patients or wards, requests for special investi-
gations (that is, red blood cell count, lumbar
puncture, etc.) or even progress notes. At the
same time, he places a check against the appro-
priate printed heading on the left.
These blanks are turned in to the efficiency
clerk's office at noon each day, and are there
sorted into groups, according to the heading
checked. From these a daily summary or report
is made by a stenographer for the information of
the superintendent, the material being thus clas-
sified and grouped by wards. From this summary,
there will be excluded those reports which con-
THE MODERN HOSPITAL
263
sist nierelj' of progress notes or requests for
special investigations.
All reports bearing upon the condition of pa-
tients will then be turned over to the clinical
stenographer, who will copy them into the med-
ical record of the individual patient. The stenog-
rapher will also, from these reports, make out
any blank for reporting special incidents, such
as injury to a patient, which may be required,
and will submit them to the physician for his sig-
nature. The various records and reports are
thus made automatically without further action
on the part of the physician.
Critically ill
Sickness
Symptoms
Transfer
Injury
Assault
Suicide
Escaped
Parole
Discharged
Death
Administrative
Progress Note
Request for Treatment
Name Ward Date
Signed
Fig. 3. Blank to provide for notice to the efficiency clerk of requests
for special examinations, transfers, etc., and also to keep the
superintendent informed of important happenings. These blanks
are made up in pads measuring 4 by 6 inches.
A report that a patient is critically ill, has es-
caped, or died, will also lead to a check upon let-
ters or telegrams notifying relatives or friends,
thus rendering more certain the performance of
these highly necessary duties.
2. Correspondence. — All correspondence con-
cealing patients requiring answer by a physician
will go through the office of the efficiency clerk
who will, each morning, enter upon the physi-
cian's duty card the names of patients about
whom an inquiiy has been received in the past
twenty-four hours. The clerk will also collect
the records of the cases, and hand them with the
letters to the physician. This enables the latter
to see his patient without having to make a spe-
cial trip, and to collect the necessary information
before answering correspondence. It also serves
to keep check upon the promptness of replies.
3. Visitors. — The efficiency clerk will make
appointments with all visitors who wish to see a
staflf physician, who sets apart a certain time in
the day for such interviews. This has been found
to effect a very great deal of saving of time for
both the physician and the visitors. The clerk
will also have ready at such time the records of
the case so that the physician may have available
all necessaiy data.
COMMENTS
The system is devised, of necessity, only for the
purpose of routine work. Emergencies must be
met as they arise. In actual practice it has been
found to result in a very great saving of waste
time. Regular examinations of all patients have
led to the detection of many unsuspected ail-
ments, some of which might otherwise have re-
sulted in sudden, unexpected death. In spite of
the reduction in the size of the staff due to the
war, more and better records are being obtained.
It is also possible to see at a glance just how
much attention has been given to any particular
patient.
It has been found that the daily summaries of
happenings in the institution are made out more
promptly, and that they are rendered more use-
ful by reason of the grouping which is part of the
system.
The physicians have, in a few instances, been
inclined at first to resent the introduction of the
system, but, without exception, when they have
realized what they are saved, and how they are
enabled to devote themselves more fully to med-
ical work and can arrange an orderly sequence of
the day's duties, they have become enthusiastic
for its adoption.
Heliotherapy and X-rays in the Treatment of Surgical
Tuberculosis
Heliotherapy and x-ray treatment should be regarded
merely as adjuvant methods in the conservative treat-
ment of surgical tuberculosis, and not as substitutes for
other methods of know-n and proved value. Sunlight has
a direct action on superficial lesions, due to its bactericidal
power, and an indirect action which produces favorable
constitutional effects and benefits deeply seated lesions.
Sandy and red-haired patients often show little pigment-
ing power, and the constitutional effects of the sunlight
treatment are then lacking. Failure to induce pigmenta-
tion is often associated with latent tuberculosis even
though all clinical signs are absent. The constitutional
effects of sunlight are very marked. Metabolism and
oxygenation are increased and the rate of respiration is
diminished. Elimination is stimulated. Red cell forma-
tion, hemoglobin, and leukocytosis are increased. Helio-
therapy in surgical tuberculosis is contra-indicated where
pigmenting power is absent, in amyloid disease, and in
certain acutely septic cases until improvement by other
means has been effected.
X-ray treatment is most valuable in cases of tuberculosis
adenitis, especially in conjunction with other methods of
treatment. Its use is attended with danger in abdominal
tuberculosis. It is also contra-indicated in tuberculosis
disease of the genital organs.
The method is described by H. J. Gaurain in a recent
issue of the Proceedings of the Royal Society of Medicine.
264
THE MODERN HOSPITAL
Fi^. 1. The Ashland General Hospital, which ha. recently had an extension o( three stories and basement.
A COMMIISITY HOSPITAL THE OUTGROWTH OF POPULAR DEMAND
The 4shland General Hospital, Built by an Association of Over Three Thousand Con-
tributind Members, One of Two Institutions Supplying Hospital
Facilities for a Community of Seventy Thousand
By J. M, DODD, M.D., Secretary Wisconsin State Board of Medical Examiners, Ashland, Wis.
THE Ashland General Hospital was the out-
growth of a popular demand and has suc-
ceeded beyond the fondest hopes of its founders.
It began in the fall of 1916. An organization
was formed and a campaign put on during the
month of January, 1917, for $40,000, under the
direction of Mrs. Elizabeth Currier, which netted
the proposed amount on schedule time, and an-
other campaign a few months later added the sum
of $20,000.
The work of acquiring property then began
with the purchase of the Wilmarth home, an old
colonial structure, a model of architecture in its
day, with ample grounds to provide for all future
extensions. Provision was made to convert the
building into a hospital until the necessary addi-
tion could be built for the hospital proper, and
then use the old part for administration and
the nurses' home. Twenty-four beds were placed
in five rooms and the necessary hospital equip-
ment was installed.
On June 12, 1917, the first patient was admitted
and though, with the exception of one private
room, only ward service could be provided, at the
end of the first year 405 patients had been ad-
mitted.
Coincident with the acquisition of the property,
plans were made for an extension 40 by 100 feet
with basement and three stories. The basement
was built last year. The accompanying sketches
show the plans as made after consultation with
various hospital authorities, including Dr.
D
Passage to admin-
istration building.
Kitchen.
Maids' dining
, Diet kitchen.
. Stairway.
6. Drug room.
7. Laundry.
S. Laundry.
9. Autopsy TOO
10. Ironing roor
11. Drying room
12. Laboratory.
BASEMENT
13. Dark room.
14. X-ray I'oom.
15. Elevator.
m. 16. Receiving room.
" Toilet.
IS. Nur..
bath.
5 h(
19. Trunk room.
20. Cold storage.
21. Storage.
22. Vegetable storage.
23. Fuel.
24. Furnace.
25. Fuel.
Jr"
Fi^. 2. Basement plan of Ashland G'
addition : the wing on the left is
ministration building and nurses'
THE MODERN HOSPITAL
265
FIRST FLOOR
. Passage to atim
n- 7.
Stairs. 16. Private room
2.5.
istration build- 8.
Dressing room. 17. Private room
26
ing and nuis
Quiet room. Ig. Private room
home.
10.
Men's ward. 19. Private room
27.
. Private room.
11
Smoking room. 20. Vestibule.
28.
Kitchen.
12.
Toilet. 21. Reception hall. 29.
Pantry.
13.
Ward. 22. Office.
30.
14.
Elevator. 23. Doctors' roon
IS. 31.
Stairs.
. Private room.
15.
Toilet and bath. 24. Librarj-.
SECOND
FLOOR
. Su
n parlor.
B.
Diet kitchi
n.
11.
Sun pai
lor.
IR.
Pr
vate
room
21.
Stairs.
25
. Pr
ivate room.
7.
Stairs,
12.
Toilet.
17.
Pr
vate
22.
26
Bath.
. Pr
ivate room.
Dressing i
oom.
13.
Ward.
IK.
Pr
vate
23.
27
Bed room.
Quiet roon
14.
Elevato
19.
Private
room.
24.
Dormitory.
28
. Pr
ivate room.
10.
vard.
1.1.
Toilet.
20.
Ha
U.
THIRD FLOOR
Delivery room.
8.
Operating room.
15.
Toilet.
Obstetrical -.vard.
9.
Operating room.
16.
Private room.
Diet kitchen.
10.
Sterilizing room.
17.
Private room.
Stairs.
11.
Nurses' dressing
18.
Private room.
Private room.
room.
19.
Toilet.
Anesthetic room.
12.
■Work room.
20.
Nursery.
Doctors' dressing
13.
Toilet and bath.
21.
Supply room.
room.
14.
Elevator.
22.
Work room.
Hornsby and Mr. Sturm of Chicago. The com-
bined suggestions were worked out by the archi-
tect, Mr. Wildhagen of Ashland, and a very sat-
isfactory arrangement of rooms and conveniences
is the result. The new addition is well on the
way to completion, and will be ready for patients
about October 1. It will accommodate sixty beds,
with room for considerable expansion in capacity,
if necessary. The cost of construction of the new
addition will be about $60,000, and this has been
reduced considerably by having bought the brick
and much of the building material last year.
The architectural design is attractive and in
keeping with the style of the old building. The
new structure is built of brick and reinforced
concrete, the facing being a red paving brick with
Bedford stone trimmings. Each floor, including
that of the attic, is made of hollovv' tile and rein-
forced concrete. The stairs are of concrete and
the partitions of gypsum plaster tile, making the
266
THE MODERN HOSPITAL
building fire- and sound-proof. The floors are
to be of concrete, specially treated to make a
smooth, non-absorbent surface. Conduit is laid
in the floors for lighting, telephone, and silent
signal systems. An automatic electric elevator
will be installed. Stairways will be enclosed, and
each room is provided with a ventilating flue. A
sun parlor is located at the ends of the main cor-
ridors and just outside the large wards an
orchard, a garden, and a small park make the
grounds surrounding the hospital most inviting.
The hospital is one of two that supplies hospital
facilities for a community of some seventy thou-
sand people. It will be equipped and conducted
in strict accordance with the best principles of
the healing art. It will have an organized staff
of doctors, who will specialize in the various lines
of practice. Already a training school for nurses is
in operation under direction of a competent super-
intendent, and the prospect for the future of both
the hospital and the school is especially bright.
It may be of interest to add that this hospital
is being built by an association of contributing
members of over three thousand, and we expect
it to be supported by its earnings. An experience
of thirty years in hospital work tells me this is
possible, and it has been proved by the work we
have done for over a year in the old building,
where we have made an initial start with about
five hundred cases.
HOSPITAL ACCOUNTING
Value of Classified Distribution of Expenditures — Administrative Expenses, Profes-
sional Care of Patients, Department, General House and
Property, and Corporation Expenses
PORTER AND HERBERT K. CARTER, of the Staff of The Modern Hospital.
[Continued from September issue, p. mi
the hospital. In addition to this, they should be
EVERY hospital should be, and many are, re- shown the amounts expended for food, patients,
nuired to make a classified distribution of all staff, and help; for salaries and wages, drugs,
By CH.\RLES a.
DISTRIBUTION OF EXPENSE
VERY hospital should be, and many are, re-
quired to make a classified distribution of all
expenditures for each year for comparative and
statistical purposes. These records are worth just
what the management of the institution makes
them as a basis for future operating and man-
agerial policies and comparisons with other hos-
pitals.
Cities that pay for the ambulance service of
a hospital usually require the institution to keep
an estimate of the cost of such service, the State
for the care of compensation cases for which it
pays, and the United Charities Funds associations
for the cost of care of all free ward patients, on
which they base their allowances to the hospital
of funds collected by them. These figures are
easy to obtain, and their value for comparative
purposes is limited to the use made of them by
the Superintendent and the Board of Managers of
the hospital.
A complete system of cost keeping is more sim-
ple and accurate than results obtained by trying
to separate certain specific costs from the whole
list of expenditures, and the results obtained are
of much greater value.
The managers and oflicers of the organizations
to whom reports are made usually require a state-
ment of the amount spent in corporation affairs —
management of the hospital, professional care of
patients, maintenance of buildings and equipment,
and in the operation of the various departments of
medicines, and supplies of all kinds in more or less
detail.
The Superintendent should go still further into
the expenditures, so as to show what has been spent
for each main division of the food supply, such
as meats, bread, butter, eggs, milk, cereals, fruits,
vegetables, etc. ; each division of supplies for the
various departments; for equipment, apparatus,
and capital expenditures. To obtain such a distri-
bution of expenses, it will be necessary to divide
the hospital into its principal divisions, such as
Corporation, Administration, Professional, Care
of Patients, Departments, and General House and
Property ; then to subdivide these two main divi-
sions. Departments and General House and Prop-
erty, into their components, and to classify the
expenditures of each of these groups and units.
In the next few pages is shown the method of
classifying these expenditures in as much detail
as will be necessary in the average institution,
numbering the accounts so that they may be ref-
erenced in the Charge Register (Form 13) to the
Invoice Jacket from which they are entered.
1. ADMINISTRATION EXPENSES
1. Salaries {Officers' and Clerks') .—Indndes
the salaries of the general officers of the hospital,
their assistants and clerks, whose salaries are not
chargeable to any department or other main
THE MODERN HOSPITAL
267
group. Care must be taken not to include officers
and clerks strictly engaged in the aflfairs of the
corporation. If certain of these are spending part
of their time in the affairs of the corporation, a
proportionate part of their salaries should be so
charged. This account includes the salaries of
the Superintendent and his assistant, the account-
ants and clerks, cashier, purchasing agent, com-
pensation clerks, stenographers, infoiTnation
clerks, etc.
2. Stationery and Printing. — The cost of the
printing of annual reports, books, forms, charts,
paper, stationeiy, and miscellaneous printed mat-
ter is included under this heading.
3. Postage. — The cost of all postage used in
conducting business of the hospital is charged to
this account.
4. Telegraph and Telephone. — Included in this
account are all expenditures for telegraph service,
including operators, toll charges, and mainte-
nance.
5. Legal Expense. — This account includes all
fees and retainers paid for services of attorneys
and collectors, cost of suits, notarial fees, etc.,
expended in the operation of the hospital, but not
those due to the cooperate business of the insti-
tution.
6. Furniture and Fi.L'tures. — All expenditures
for the purchase of furniture and fixtures pur-
chased for the hospital and not chargeable to the
corporation are charged to this account.
7. Miscellaneous Expenses. — Appearing under
this caption are all expenditures for items not
chargeable to any of the preceding accounts, in-
cluding carfares, traveling expenses, subscriptions
to magazines and periodicals, expressage, etc.
II. PROFESSIONAL CARE OF PATIENTS
8. Salaries and Wages. — This account includes
the salaries and wages of doctors, superintendent
of nurses, head nurses, nurses, orderlies, and
others engaged in the care of patients, whose sala-
ries or wages are not chargeable to any of the de-
partments listed under that head.
9. Apparatus and histruments. — Listed under
this heading are the costs of maintenance of ap-
paratus and instruments, but not that of new
equipment, which is chargeable to capital expendi-
tures. (See definition of Equipment and Sup-
plies, page 103, August, 1918.)
10. Equipment for Nurses and Orderlies. — The
cost of uniforms, books, and instruments fur-
nished free of charge to the nurses and orderlies
of the hospital are charged under this caption.
(Articles for which the hospital is to receive pay-
ment should be charged to material account.)
11. Medical and Siirgical Supplies. — The ex-
penses included in this account are for supplies
purchased for the general use of the hospital not
chargeable to the other subdivisions of profes-
sional care of patients, or to any of the depart-
ments.
12. Dispensary. — All salaries, wages, and medi-
cal and surgical supplies pertaining to the dis-
pensary are charged to this account.
13. Pathological Laboratory. — Chemicals, sala-
ries, wages, and miscellaneous expenditures of all
kinds incurred for the pathological laboratory are
charged to it.
14. X-Ray Service. — Salaries and wages, plates,
tubes, and miscellaneous supplies are chargeable
to this department.
15. Social Service. — Listed under this caption
are salaries and wages, medical and surgical sup-
plies, clothing, and miscellaneous expenses in-
curred for the visiting nurses and doctors.
16. Emergency Ward. — Salaries and wages,
medical and surgical supplies, and miscellaneous
expenses chargeable to the emergency ward are
listed in this account.
III. DEPARTMENT EXPENSES
17. Amhulance. — This account includes wages,
gasoline, supplies, repairs, and miscellaneous ex-
penses incurred for the maintenance and opera-
tion of the ambulances.
18. Meat, Poultry, and Fish (Stetvard's Depart-
ment) . — This account includes beef, mutton, veal,
pork, ham, bacon, poultry, game, fish, and shell-
fish.
19. Dairy Products (Steivard's Department).
— Milk, buttermilk, cream, cheese, butter, and eggs
are listed in this account.
20. Groceries and Provisions (Steward's De-
partment).— Flour and cereals; bread and crack-
ers ; coffee, tea, cocoa, and chocolate ; yeast and
baking powder ; sugar, molasses, and syrups ; lard
and other shortenings; spice and flavoring ex-
tracts; salt, pepper, and condiments; canned
soups; canned fruits; canned vegetables, and
other foods and food products are listed in this
account.
21. Fruits and Vegetables (Steward's Depart-
ment).— Appearing under this caption are pota-
toes, apples, oranges, and lemons.
22. Miscellaneous. — This account includes sala-
ries and wages, repairs, general supplies, ice,
table water, and other items not chargeable to
the steward's account and not included in the
other four lists.
23. TrL 'ning School. — Salaries and wages, sup-
plies, and miscellaneous expenses are listed under
this caption.
24. Laundry. — Included in this list are wages.
268
THE MODERN HOSPITAL
soap, starch, miscellaneous supplies, and repairs
chargeable to the laundry.
25. Housekeeping. — This account includes sala-
ries and wages and miscellaneous supplies.
IV. GENERAL HOUSE AND PROPERTY EXPENSE
26. Heat, Light, and Power. — All salaries and
wages, fuel, oil, electric lighting, repairs, and mis-
cellaneous supplies used by this department
should be charged to this account.
27. Maintenance of Buildings. — Charge for
labor, materials, general supplies, and miscella-
neous expenses incurred in the maintenance of
buildings should be charged to this account.
28. Maintenance of Equipment. — Salaries of
mechanics and supplies. This account includes the
cost of maintaining elevators, fans, refrigeration
system, and other equipment, the charge to which
cannot be distributed to any specific departments.
29. Insurance and Taxes. — The total cost of all
building insurance, water taxes, etc., are included
in this account.
30. Rent. — This account includes the cost of
all buildings used for hospital purposes, except as
a dispensary, laboratory, or the training school.
Were the expenditure for one of these three men-
tioned, it would be charged directly to the de-
partment for which it was expended.
31. Miscellaneous. — Items that do not pertain
to any of the accounts already given may be
placed in the column for this purpose in the
Charge Register and properly described.
V. CORPORATION EXPENSES
32. Salaries {Officers' and Clerks'). — Included
in this account are the salaries of officers and
clerks exclusively engaged in the management of
the corporation, and the proportional part, if
any, of salaries in the administrative offices which
are chargeable to this account.
33. Stationery, Printing and Postage. — This
account includes all moneys spent for stationery
and printing used by the Treasurer for his books
and that of the Campaign Committee for raising
funds and postage for same.
34. Legal Expense. — All fees and retainers paid
to attorneys, costs of suits, etc., which are charge-
able solely to the corporation are included in this
account.
35. Interest. — Interest on all notes and loans
payable made by the Treasurer of the corporation
should be charged to this account.
36. Miscellaneou.^. — In this account are all
charges for miscellaneous corporation expenses,
such as telephone, telegraph, car fares, and other
items not chargeable to any of the four accounts
above mentioned.
CURRENT EXPENSES FROM SPECIAL FUNDS FOR
STATED PURPOSES
37. Current Expenses from Special Funds for
Stated Purposes. — This account includes expendi-
tures of all special funds held for stated purposes,
and an itemized list should be shown.
CAPITAL EXPENDITURES
38. Capital Expenditures. — This account in-
cludes all expenditures for additional land, build-
ings, machinery and equipment, apparatus and in-
struments, and furniture and fixtures.
MATERIAL
39. Material. — All material purchased should
be charged to this material account. (See defini-
tion, page 103.)
This distribution of expense is arranged in as
much detail on the Charge Register as is made
necessary by the volume of transactions falling
under each of the accounts mentioned in the dis-
tribution of expenditures. All of these accounts
may be shown on the Invoice Jackets. This dis-
tribution is indicated on the Invoice Jackets and
Charge Register, so as to facilitate the gather-
ing of the total amount spent for each class or
subdivision of accounts and the total expenditure
of each of the main groups mentioned in the dis-
tribution. Having gone this far, the expense
analysis and budget systems, as later explained
are easy to keep up.
INVOICE JACKETS .
The Invoice Jacket (Form 14) shows the dis-
tribution of expenditures to be made in the
Charge Register.
The classification of expenses into groups ac-
cording to the data required by the United Hos-
pital Funds Associations, State Boards of Chari-
ties, and the hospital itself for comparative and
statistical information, as determined in distri-
bution of expense, is shown on this form.
Every invoice, pay roll, and petty cash state-
ment should have a jacket made out, showing the
distribution authorized, attached thereto, and
then entered in the Charge Register.
The Invoice Jackets, except those paid as made
out, should be filed in a drawer, marked "unpaid
bills," under the dates due. As they are paid
they should be transferred to a file marked "paid
bills" and arranged in numerical sequence. At
the beginning of the following month some of
these will need to be referred to in making out
the Expense Analysis. After this report is com-
pleted, these jackets should be done up in pack-
ages of five hundred or any convenient number, a
slip placed on the face of the package giving the
THE MODERN HOSPITAL
269
INo, \H-9Z flm't $
THE MODERN HOSPITAL F^yor of
Date Te.rms
D/5TRIBUTION
PlM0U!-4T
no
D.'5TRIBUTIO(N
Amount-
(No.
C/APIT/AL EXPENOITURE.S
Total. Brought Fwd.
.STEn-Ai^o's Dep^ Con'-r.
/^y"
ADMiiNi£-rRA-r;vF E'xPEM5E5
La,\-y e n
/1c,
3ala^/e-5 8c /raaCsS
J.
Sv/'ces f- F/arcrinc/ EyirX4cfi
,-^;
6-tci-rione^Li &' Pr-i'rjtino
Z.
Sa/-/; Peibter -^ Con^imcn-Kt
I'it
Poitaae-
3
Cc,r,ne.a/ Si>i'/>s
/■?/
Tt-learcipn &. Telcbhcne
t
Frr/^
/*A-
LcujL ExPEnise
s
/'eae^ib/es
/•?i
Furnitufe t Fii-ture,^
Frc/n 1- f'ece'raib/es
X.O
Miscelloineci's
7
Paf-ciTcei
z.oa
PnorEiSioriAL Cape orPflTiEnT-s
/V/ J c e//a nec-fs
;li
^L^/^-irUi ^wr rsvfisEi
Bo
.>-/{ tyj AV/f id s
9b
Ambi^/ance. S7-/y
^ia
^p^ciui ni-mei,
a^
Subb/iii
2^h
•ii-foes
Sd
n&hJ'rj
ZZc-
Cr^icrliei
tfe
Tr&/'r/r£f Schop/
-i3
L'nif'orm}- OToirtt-
/O
App^rvm Jt tntri/menCi
V
taiJrdru
Z'*
t'UJ/Cu/ cr Oorqii^al ^uPPLias \
11
'
DIspensat- y ~ ^ct/ufie^
/i.
Hcfse/reei'/nci
i£~
AfeolicoT cr ^i r^iCCil SUPP.
■*"j-«
GEneRiM. House dc V^omsfiTy
Pa-tholoqicctI L^bOKtJtor u df-n
/3
Heat. Liqht v- Pai^er
Z6
•SuPPt'iE:s
/3 a
Main^ffrance 3i//i.oi/sio.<;
-J7
> «/»V S.dL Ir
/V-
Sup/^liti
/Hair-te.nanC& EouipntErtT
2.8
Social. Service KrHli S^h
IS
Me^/c^i Si'PplteS
/.fa
T/^Si/r^<^nce. or Taxc6
Z9
•5i/rciicai Surip/iti
/Sb
.'^er-r
30
C/crfiinQ
/SO
nr/sce lion eof.s
SI
^merctencq nitrcJ ^fh'
/6
Cc« PORAT-ior-( EypEP^se^
*ie^ic£,/ 5^^-r:/tii
/Ca
Sa?ar/ei
3i.
Sur-cficat SiV.o/iej
/(, *
Sf-at/cncr-w, Pr/nt/no Postcat
33
Lenai £)ipe/v.f£.<.
3f-
rn-rereit
3S-
3c:,
DEp/»fiTrviEnxAu Expanses
Srcv.rJs r>fok Si-fr'^cics
/7
fV.Yf
/7.i
CunnENT P»/?'j PnoM SpecinL Fi/s.
37
Pc . Cry
/7i}
/7c-
Dairu T^rodLJcTi - /Yfilk
/y
Butter
/j>>
MATEBIAI-
■?f-
Crea.-^
/re
Cf7ce.6e,
/ya
/fe.
Grocer ici - f^/ci/rr^c'e reefs
/^a.
Bread r-CrCii/ffrS
/fb
Ccffec. Tea, Cccco^ChcwU
/■^c
Yeas^ BifKin^ Pcir^ercti
/■icJ
Sf^a-^ Mc/hiSei f-^i/ri/p-5
/f&
TCTAU FORtVARD
To-r/M-
1
_
Jacket. Actual si:
dates and numbers of the jackets included, and
sent to the vaults for safekeeping.
These Invoice Jackets are not used as vouchers
because the form of check used is a sufficient legal
receipt in itself.
PAY ROLL AND TIMEKEEPING
The Pay Roll (Form 16) is best kept in a loose-
leaf binder, using a sheet for each department of
the hospital, such as Administration ; Emergency ;
Dispensary ; Heat, Light, and Power ; Professional
Care of Patients; Domestic; Steward's Depart-
ment, and General.
Administration includes Superintendent, Assist-
ant Superintendent and clerks, purchasing agent
and clerks, receiving clerk, infoi-mation clerks, ac-
countant and clerks.
Emergency Pay Roll includes emergency nurses
surgeons, orderlies, etc.
Dispensary Pay Roll includes all those people
whose services are used by the Dispensary, as
clerks, doctors, surgeons, nurses, etc.
270
THE MODERN HOSPITAL
Heat, Light, and Power Pay Roll includes en-
gineers, assistant engineers, firemen, oilers, eleva-
tor runners, mechanics, and others assisting in
the maintenance of buildings, heating, lighting,
etc., and may include ambulance drivers.
Professional Care of Patients'
Pay Roll includes superintendent
of nurses, head nurses, orderlies,
medical and surgical services,
dietitians, and all others en-
gaged in assisting the care of
patients.
Housekeeping includes housekeeper and those
under her supervision.
Steward's Department includes storekeeper,
chef or cook, kitchen help, and all others engaged
in preparing or assisting in the preparation and
delivery of food.
General Pay Roll includes all those who have a
department where but one or two are employed, as
pathologist, chemist, and radiographist.
The Pay Roll should show the rate per month
of those employed by the month and the rate per
hour of those employed by the hour. There should
be columns for total pay, deductions for advance
payments, net pay, time check numbers, dates, and
remarks.
The best way to obtain information for making
up the Housekeeping Pay Roll is by use of a time
clock placed under the watchful care of the As-
sistant Superintendent or Matron. Regular time
books may be used by the head of each department
may be given brass checks, bearing their num-
ber, at time of employment, and these are to be
presented to the paymaster and returned with
their pay.
A form of Time Check (Form 15), to be used
no
T)fwE Check- Mot Megoti/^ble INo.
The Modern Hospital^
Dsi-e /^/
/yan?c /Vo
Dcjlt
Ocurfmfian
^A'j
/tJft.
ff/TfOvnf
TcTje Ro^c
fin70ut7€ 7J3- D 0U<3 rs
T//7te ^i r-an unatr fTdime^
ftecciretf P^ymeni: m -full
fJmounf 8y
Form 15. Time Check. Actual size, 6 by 3 inches.
if desired. Great care should be taken in register-
ing overtime.
Particular attention is called to the Pay Roll
(Foi-m 16), which has been designed with a view
to saving time.
Forms ordinarily used require the signature of
the payee, but this is not necessary, as it neither
prevents padding nor shortages caused by error.
Every employee should be numbered, whether
time clocks are in use or not. The pay is placed
in envelopes bearing these numbers, and all em-
ployees are required to give their name and num-
ber when calling for their pay. Domestic help
h"^ fi 1 l\\JL^ L- Pert od End inq
/^p^roved
Vt*is
«E rorou „„„„„„
rtET Put c^eln
PeiMflBKa
L —
[ — L — J
Form 16. Pay roll. Kept in loose-leaf binder, with binding margin
to be added at left-hand side. Actual sizes, upper sheet. 121^ by 11
inches ; lower sheet, 9 by 11 inches.
when settling up with help at any and all times
in advance of the Pay Roll date, is shown. These
are paid out of the petty cash fund, and, as a check
is dravvTi to cover the Pay Roll fully, the amount
left over after filling the envelopes should equal
the total amount shown by these time slips and
be returned to the fund and slips removed.
[To be continued]
A Few Civil War Hospitals.
In December, 1864, the United States had in active
service 192 general and special military hospitals with a
capacity of 118,000 beds. In Washington alone were 25
hospitals with 21,426 beds. When the Civil War broke
out hospitals had to be improvised. Churches, college
buildings, factories, hotels, etc., were converted into hos-
pitals. Later in the war a great number of hospitals
were erected on the pavilion plan. The pavilions, long,
low one-story structures, provided with the so-called
"ridge" ventilation, were connected by a covered corridor.
In the Hicks Hospital in Baltimore, the covered corridor
had the form of a semicii'cle from which the 18 pavilions
radiated in all directions, while the administration build-
ing was placed in the centre of the circle. In the Lincoln
Hospital at Washington, the pavilions were arranged en
echelon in the shape of a V, the inner ends being con-
nected by a continuous covered corridor. As the war
advanced many improvements were made in the con-
struction of the hospitals, especially with regard to light-
ing, heating and ventilation. The covered and closed
corridors of the earlier hospitals were later replaced by
corridors entirely open on the sides.
These hospitals are described by Lieut.-Col. C. Wood
in a recent number of the Military Surgeo7i.
Golden friendship is not a common thing to be picked
up in the street. It would not be worth much if it were.
Like wisdom it must be sought for as for hid treasures,
and to keep it demands care and thought. To think that
every goose is a swan, that every new comrade is the
man of your own heart, is to have a very shallow heart.
—Hugh Black.
THE MODERN HOSPITAL
THE DEPARTMENT OF LABORATORIES
271
Construction of Laboratories Ordinarily Given No Expert Consideration in Building of
Hospitals— Organization, Director, Budget, Routine, Record-Keeping, Research, Etc.
By max KAHN, M.A., M.D., Ph.D., Director cf Laboratories, Beth Israel Hospital, New York City.
"Vere scire est per causas scire — To know truly
is to know through causes — and he is the scientific
physician or surgeon who seeks and determines
causes; for only when the cause is deduced can
treatment be rational." (Adami.)
IT is a curious and surprising fact that, in the
building of hospitals, the construction of the
laboratory department is given no expert consid-
eration. Usually after the hospital has been com-
pletely erected, certain space, unsuitable for any
other purpose, is assigned to the laboratory. It
is thus that we find this department frequently
located in basements, in out of the way nooks and
corners, in outhouses or roof structures built as
an afterthought. The laboratory is gloomy, the
ventilation unsuitable, and the general conditions
such as to make the scientist working there cog-
nizant of a spirit of depression in his assistants
and help. It is only, it seems, an Epimetheusian
consideration which prompts the hospital authori-
ties to build adequate quarters for the laboratory.
Thus we see some of the largest hospitals in the
countiy, erected and equipped for all work (ex-
cept the most important), and getting along for
some years with a makeshift diagnostic labora-
tory until, finally, either adjacent ground is
bought and a laboratory building erected, or an
additional floor is built on the roof, or some othe]-
arrangement is made to house the scientific de-
partment.
The usual architect v%'ho draws the plans of a
hospital — I have seen several such plans — is
aware that the establishment is to have labora-
torj' quarters, and he devotes some space to what
he calls a "urine room" and a "pathological labo-
ratorj'." The average superintendent of the hos-
pital is able to point out to him how m.uch space
is to be devoted to the kitchen, to the scullions'
chambers, to the steward's department, and to
the doctors' recreation room, but he has not the
knowledge to instruct the architect what the re-
quirements of the laboratory department are. If
space is lacking, it seems always proper to cut
off some of the space devoted to the so-called
"urine room" and use it for any other more
urgent purpose.
So far as the laboratory department is con-
cerned, the hospital authorities do not seem to
learn from the mistakes of their neighbors. It
takes several generations of laboratory directors,
who, dissatisfied with the cramped, unsanitary
quarters, are always protesting and pleading for
better surroundings, to influence and persuade
the board of trustees to devote money to labora-
tory extension. The lay board, and sad to say,
the average medical board, judge the value of a
laboratory department not by the experiences of
other hospitals, but by the work done by their
own laboratory staflF. If the scientist in charge
is a capable, energetic, and learned man, and if,
in addition to these qualities, he has much tact,
it is usually possible for him to obtain a hearing.
Experience shows, however, that the first and
second succeeding laboratory directors resign in
a dudgeon, and the authorities are compelled to
grant certain inducements to the new man, who,
taking a lesson from the history of his prede-
cessors, controls his temper and allows the influ-
ence of time and the suasion of his work to obtain
for his department its just dues.
It does not seem to occur to the trustees to
build a fulljr equipped laboratory and judge the
scientist by his work, dismissing him if he is in-
capable or inefficient. On the contrary, they
always judge of the abstract value of a laboratory
department for the hospital by the efficiency of
the man in charge.
May I take the liberty in the following pages
of discussing the question of the department of
laboratories, and point out to the lay executives
certain matters which appear very important to
the scientist in charge of the laboratory?
It must be definitely understood that the twen-
tieth century hospital must have a laboratory —
not a makeshift, two by four, "urine room," not
a gloomy, unventilated, poorly cleaned cranny,
but v\'ell-constructed, properly lighted, scientifi-
cally equipped quarters. A hospital has been de-
fined as a hotel with an operating room and
laboratoiy attached. It is just as improper to
have an inadequate laboratory as a dark and dirty
operating room.
It is questionable whether the patient gets any-
thing more than hotel comforts from a hospital
having a poor laboratory. It is in the laboratory
mainly where accurate diagnosis is made. With-
out laboratory confirmation, no diagnosis is cer-
tain. It is true that in many instances the labo-
ratory serves but to make an accurate post
mortem diagnosis. But it is futile to treat a
patient the cause of whose disease has not been
272
THE MODERN HOSPITAL
determined. Vere scire est per caiisas scire, said
Bacon. It is only groping in the dark to prescribe
therapy for an unknown complaint.
The lay patients do not know of the tremen-
dous amount of work that the hospital laboratory
does or should do for them. They are aware that
somebody must be cooking for them, that some-
body is cleaning and washing for them. They
see the surgeon dramatically and sometimes melo-
dramatically impressing them with the delicacy
of the operation. But they are not aware — they
can not be aware — of what goes on before the
operation is recommended. How many and va-
rious and difficult are the tests made before a
diagnosis is possible! Nor does the rare melo-
dramatic surgeon deign to inform the lay patient
that the gall-bladder which he removed as being
the cause of all evil has been reported normal by
the laboratory. The patient, not knowing better,
is minus a gall-bladder and minus a fee, but he
still ventures to complain of pain in the same place
and with the same insistence. In the medical — in
contradistinction to the surgical — ward the labo-
ratory is called on to do more work. It is called on
to study the secretions and excretions, to analyze
the various fluids of the patient, and to inform
the physician in charge what the result is. Treat-
ment, in so far as it can do good, is nowadays
directly proportional to the amount of laboratory
work. Given the diagnosis, it is a simple matter
to treat — if treatment is possible — any case. The
rub is in ascertaining the diagnosis.
I wish to discuss very briefly the laboratory
question under the following headings : (I) organ-
ization; (II) the laboratory director and the med-
ical staff; (III) the budget; (IV) the routine
sy.stem of running the laboratory; (V) the rec-
ord-keeping of the laboratory; (VI) the research
work of the laboratory.
THE ORGANIZATION
I sometimes wonder whether a small hospital
is a boon. It is true that the patient is sheltered
from the cold and is given his meals in such a
hospital, but besides this little is done for him.
There is usually no laboratory department — I
refer to the small, provin'-;ial hospitals- -and the
physician blunders along, as best he can, without
scientific aid, as did the physicians of the by-gone
centuries.
A hospital having more than two hundred pa-
tients should have a well-equipped pathological
laboratory, bacteriological laboratory, biochem-
ical laboratory, and serological laboratory.
The various laboratories should be in charge of
men especially trained in their respective profes-
sions. It is unusual to find a man well studied in
two or more of the sciences, and to permit one
man to take charge of the work of all the depart-
ments is to invite errors and mediocrity in those
branches with which he is but superficially ac-
quainted. It may be advisable to have one man
as chief of the laboratories with assistants in the
various other laboratories ; or it may be well to
have all the laboratory men on equal footing. It
is usual to have the bacteriologist or the biochem-
ist do the serological work.
The pathological department should have four
rooms devoted to it. There should be: (a) an
autopsy room, which should be rather large, and
arranged, if possible, like a small amphitheater
so that autopsies could be performed before the
hospital staff, and the findings discussed, and
equipped with the most modern table with I'un-
ning water and drainage; (b) a microtome room,
where the pathological specimens are sectioned
and stained; (c) an examining room, where the
pathologist has his office, keeps his record and
examines the specimens microscopically; (d) a
dark room for photographic work. The patholo-
gist should have at least one assistant and a tech-
nician helping him.
The bacteriological and serological department
should have six rooms: (a) a cleaning and ster-
ilizing room, where the glassware is washed and
sterilized, and where mediums are prepared, in
charge of one technician and a porter; (b) a bac-
teriological incubation room, where the organisms
are incubated and the slides stained ; (c) a bac-
teriological examination room where the micro-
scopical work is done and the records kept; (d)
a serological room, where the Wassermann and
other complement fixation tests are performed;
(e) a reception room, where patients wait to have
their blood taken, etc. ; (f ) a transplant room,
where inoculations from one medium to another
are made. The bacteriologist should have one
trained assistant and one technician helping him.
The biochemical department should consist of
five rooms: (a) the chemical laboratory, where
the analyses are made; (b) a hood room, where
digestions involving the formation of fumes and
odors are performed ; (c) a titration and balance
room; (d) consultation and record room; (e) a
dark room for polariscopic work. The biochemist
should have one assistant and one technician.
There should be, in connection with the labo- '
ratoj-y, a museum, a general record room, a gen-
eral library, a general store room, and an animal
room, which should be roomy, light and well-ven-
tilated. A porter should be assigned to the clean-
ing of the animal room and of the laboratory as
a whole.
THE MODERN HOSPITAL
273
II. THE LABORATORY DIRECTOR AND THE MEDICAL
STAFF
Properly to avoid friction between the physi-
cians and the laboratory department, it is essen-
tial that at least one member of the laboratory
staff should be represented on the medical board.
In this wise all criticism could be directly
answered, and all complaints explained or
investigated. It seems unjust to the labora-
tory man who has spent more time to study
his profession and who receives less mate-
rial reward in the pursuit of it, to be treated
like an educated employe by the other visiting
physicians. It appears a characteristic trait of
physicians to lay the blame on the laboratoiy
department when things do not go well with their
patients, and often undeserved censure is flung
on the laboratory. With the presence of the labo-
ratory representative on the staff, the needs of
the scientific department could be better urged
and the improvement suggested more impres-
sively defended.
III. THE BUDGET
The laboratory is a source of expense to the
hospital. So are the culinary department and the
laundiy. The laboratoiy is just as essential as
are the other two departments.
Curtail the expense of the culinary department
and everybody is dissatisfied. The patients will
complain, as well as the doctors, the nurses, and
the help. They are soon made aware that their
inner selves are not as well suited as previously.
Reduce the expense of the laundry and hygiene
suffers. Cut down the expense of the laboratory
department and conscience is outraged.
If a hospital has many private patients, it is
proper that they should be charged an initial
extra fee of five or ten dollars to insure that all
laboratory work will be done without further
charges. This, of course, can be done in such
hospitals as have full-time laboratory men in
charge of the various departments. In one hos-
pital in Pittsburgh, about fifteen thousand dollars
are annually collected from a five-dollar charge
to each private case.
Generally speaking, a large hospital is to expect
an expenditure of 4 to 5 percent of its budget
for laboratoiy work. In certain hospitals, where
men v,-ork on part time and their compensation
is correspondingly diminished, the laboratory ex-
penses are, of course, proportionately less. In
those hospitals which charge a nominal fee for
laboratory work to each private patient, and
where the laboratoiy staff is on a whole time
basis, the budget for the laboratoiy may be re-
duced to about one percent of the total operating
■expense of the hospital.
IV. THE ROUTINE OF THE LABORATORY
Foi the proper and conscientious examination
of all specimens, all the analyses should be made
by the laboratoiy staff either personally or under
their supervision. All the routine urine exam-
inations, blood counts, nose and throat cultures,
sputum examinations, etc., should be made in the
laboratoiy proper and under the direct charge
of the laboratory man. To have ward laboratories
where the interns make the examinations at their
svN-eet pleasure is to invite slovenliness, ineffi-
ciency, and inaccuracy in all the routine exam-
inations. I do not mean for a minute that the
inteDis should do no laboratoiy work. I mean —
and T am convinced after many years' experience
— that the intern staff should be assigned for a
certain period of their stay in the hospital to
laboratory work, say one-sixth of their time.
During this period they would do, under the guid-
ance and with the assistance of the trained work-
ers, all the routine examinations. If several
interns spend their time in the laboratory simul-
taneously, they could be assigned to the various
departments for a portion of their time, helping
each other out when one man's work gets too
heavj'.
The method of procedure would be as follows :
All the specimens would be sent to the laboratory
before nine o'clock in the morning. All requisi-
tions for blood counts, etc., would also be sent at
the same time. The man assigned to urine work
or culture examination, etc., would find all his
specimens waiting for his analysis. The intern
assigned to blood count work would proceed to
the various wards with pipettes, etc., and take
the blood for the count.
Certain days of the week should be assigned to
Blood Chemistry, other days to Gastric Analysis,
etc. On these days the intern would pass the
stomach tubes on the various patients and bring
the specimens to the laboratoiy. Wassermann
tests are usually done twice weekly.
Of course, emergency work will be done at all
times. One intern should be assigned in succes-
sive order to emergency night work. In this way
all contingencies can be met.
V. THE RECORDS
All hospital laboratories keep records of the
w^ork that they do, but in many cases these rec-
ords are incomplete and not get-at-able. The fol-
lowing system has proved satisfactoiy :
All original reports are made on the requisition
slip. This should be done in ink and should serve
as the permanent record of the work done. These
requisitions with the report are sent to the labo-
ratoiy typist, who stamps them in numerical suc-
cession. An index card is made out for each
274
THE MODERN HOSPITAL
patient, and all the requisitions are entered here,
so that one can at any time locate all the labo-
ratory work done for any patient, as shown in
the illustration.
The t>T>ist then proceeds to make three type-
written copies of the original report. One copy
is sent to the house physician or surgeon, another
copy is filed under the test performed, and a third
copy under the name of the disease. Thus, if a
phenolsulphonephthalein test is made on John
Doe, who is suffering from kidney stone, the orig-
inal report is filed in numerical order and the
number indexed on the index card. One type-
written report is sent to the physician, the second
copy is filed under the word "Phenolsulphone-
phthalein," and the third copy under the word
"Nephrolithiasis." Such records would be com-
plete and would serve as a means to teach us the
encouragement of original investigations. On the
other hand, there are certain executives who are
trained only in economics and discipline, and who
can not discriminate between the higher scien-
tific services of a laboratory and those of the
mediocre type. Time, however, teaches them
their lesson, for it is, I believe, difficult to find a
scientist who would be willing to forego all the
interest that the science has for him in delving
in the unknown for the discouraging routine work.
It is like taking out the spices and condiments
from a meal, for research work is the spice of the
laboratory worker's life.
':R*^.4»x:::st.
_3<^fc_A,_ta.(-iL_
J.
:.• l.Z...
Ha^^ f«p,_iMA.y.
±is:o...
> "i 7 " ...
•6 IHh...
■5"7 '
Individual index card for laboratory
each patient.
value of our findings with certain tests in various
diseases. After several years had passed, the
records would prove invaluable.
VI. RESEARCH WORK
Very few capable men will wish to have any-
thing to do with a laboratory in which research
work is interdicted. It is upon his research work
that the reputation of a laboratory worker de-
pends. His future career and his present con-
tentment are in the work that he loves. To fai!
to encourage him in this work is to ruin the
morale of the laboratory and usually means the
resignation of the laboratory scientist. The repu-
tation of the whole hospital is enhanced by the
publication of the scientific researches conducted
in its laboratory, and the whole medical staff"
should insist that research problems be investi-
gated there, for the lay board is not aware of its
great importance.
The executive head of the hospital may some-
times not be in sympathy with research work.
Usually the superintendent, if he is broad-minded
and cultured, will be the most enthusiastic in the
Inexpensive Apparatus for Preparing Distilled Water
Bv ASA S. BACON, Superintendent, Presbyterian Hospital of the
City of Chicago.
Freshly distilled water is coming more and more into
demand by our physicians, for preparing salvarsan,
physiological salt solution and other solutions for intra-
vaneous use.
The cut shows an inexpensive apparatus that is used in
the Presbyterian Hospital, which is adequate to keep the
iua'ra^'f'
A simple and inexpensive device for the preparation of distilled water.
hospital supplied with freshly distilled water. Water
from the hydrant flows into the reservoir and, by gravita-
tion, through the intake. This reservoir is important, for
it relieves the pressure on the condenser and prevents
breaking. The overflow pipe prevents overflowing of the
reservoir.
The apparatus is very simple and easily installed. Its
parts can be purchased from any laboratory supply house.
THE MODERN HOSPITAL
275
THE VOLUNTEER MEDICAL SERVICEJICORPS.
An Authoritative Statement of Its Plans and Scope Reasons Why Every Legally
Qualified Physician Should Enroll Some of the Salient
Features of the New Organization.
By colonel FRANKLIN MARTIN, M.D., Chairman Medical Board, Council ok Naticn^u. Defense.
The hospital organizations of the United States
should be deeply interested in the Volunteer Med-
ical Service Corps ; first, because already many of
their leading physicians and surgeons have been
called to service in the Army or the Navy; and
second, because a considerable peix-entage of addi-
tional members of the staff will be required
within the next year to
fill the new quotas
necessary to fill the
ranks of reserve offi-
cers in the Army,
Navy, a n d Public
Health Service.
Every member of
every medical staff of
every hospital who is
not in service should
now register in the
Volunteer Medical Serv-
ice Corps. Even those
who are under forty-
six years of age and in
the draft should avail
themselves of the ad-
vantages this Volun-
teer Medical Service
Corps offers.
While ultimately forty
per cent of all doctors
of the United States
will be asked to serve
their government in
uniform either in the Army, Navy, or Public
Health Service, the other sixty per cent will be
required to care for the enormously expanded
work of the home territory. This means that
more and more of the work at home must be
concentrated in the existing hospitals, where
under systematic organization the patients can
be cared for in the greatest number, in the most
scientific way, in the shortest time. The Volun-
teer Medical Service Corps wishes to have under
enrollment every one included in the sixty per
cent of the entire medical population who is not
in military service, in order that the organization
may aid in the proper disti'ibution of doctors for
home service, including hospitals, medical schools,
war industries and home communities.
THE VOLUNTEER MEDICAL SERVICE
CORPS
First authorized by the Council of National
Defense on January 31, 1918.
Final reorganization on August 5, 1918, by
the authority of the Council of National De-
fense, including confirmation of its Central
Governing Board.
On August 12, 1918, the Volunteer Medical
Service Corps was approved by the President
of the United States, who said, in a letter to
Dr. Franklin Martin, Member of the Advisory
Commission of the Council of National De-
fense and Chairman of the Council's General
Medical Board:
"I am very happy to give my approval to
the plans which you have submitted, both be-
cause of the usefulness of the Volunteer Med-
ical Service Corps and also because it gives
me an opportunity to express to you and
through you to the medical profession, my
deep appreciation of the splendid service which
the whole profession has rendered to the na-
tion with great enthusiasm from the begin-
ning of the present emergency."
The corps also gives every medical man of the
United States an opportunity to volunteer his
services for any work that may be required of him
by his government in this time of need, under
circumstances that will obtain the best possible
efficiency and inflict as little hardship upon the
individual and the community as possible.
In the following para-
graphs an effort is
made to answer inquir-
ies in regard to the pur-
pose, scope and or-
ganization details of
the Volunteer Medical
Service Corps.
The Volunteer Medi-
cal Service Corps is an
organization which pro-
vides means for obtain-
ing quickly men and
women for any military
or civil medical service
required in the war
emergency. It furnishes
recommendations and
necessary credentials
to assure the best med-
ical service, both mili-
tary and civil. It de-
termines beyond ques-
tion the attitude of the
individual toward the
Upon request to the Volunteer Medical Service
Corps, Council of National Defense, Washington,
D. C, application blanks and circulars of infor-
mation will be sent. When received, the applica-
tion form should be filled out completely, in
accordance with instructions contained in the
circular of information. The application should
then be mailed to the Volunteer Medical Service
Corps, Council of National Defense, Washington,
D. C.
Every legally qualified physician holding the
degree of Doctor of Medicine from a legally char-
tered medical school without reference to age or
physical disability is eligible for membership, pro-
vided he or she is not already commissioned in
the government service.
THE MODERN HOSPITAL
276
Eligibility is determined upon information ob-
tained from application blanks, three personal
references and the Executive Committee of the
state in which the applicant resides. Based upon
the information thus secured, the Central Gov-
erning Board will finally pass upon applications.
This corps is not authorized to bestow rank.
Arrangements for compensation will be made
between a member requested to perform a spe-
cific duty and the agency requesting service. The
matter of compensation and place of service,
whether with or without rank, must be deter-
mined at the time said request is made. When a
member of the corps accepts service in the Med-
ical Reserve Corps of the Army, Naval Reserve
Force, the United States Public Health Service or
any governmental department, he or she will be
accorded the rank and pay incident to the service
in the department in which he or she has enrolled.
No member will be ordered to render any serv-
ice. Requests to perform specific duties accord-
ing to qualifications and availability under the
classification of the Volunteer Medical Service
Corps will be made from time to time as emergen-
cies arise.
The probable character of this service will be :
(a) Medical Reserve Corps; (b) Naval Reserve
Force; (c) United States Public Health Service;
(d) American Red Cross; (e) Local and medical
advisory boards; (f) Institutional (medical
schools and hospitals) ; (g) industrial plants ; (h)
Civil communities (caring for civil communities,
stripped of medical attention; caring for prac-
tices of physicians in military service; reclama-
tion of registrants rejected for physical unfitness ;
services to needy families and dependents of en-
listed men) ; (i) miscellaneous service.
If members of the corps are called to active
military or naval service, the order in which they
will be called will be :
(a) Physicians eligible for military duty but not en-
rolled.
(b) Physicians under fifty years of age without ob-
vious physical disability which is disqualifying, and with
not more than one dependent in addition to self (Class I
of the Volunteer Medical Service Corps), will be the next
to be called upon for actual war service. Any physician
under fifty-five years of age who is without an obvious
physical disability which is disqualifying and whose de-
pendents have an income sufficient for the support of
dependents other than that derived from the practice
of his profession, may be called upon to enroll in the
Medical Reserve Corps of the Army, the Naval Reserve
Force, or the United States Public Health Service, when
in the opinion of the respective Surgeons General his serv-
ices are needed.
(c) Physicians under fifty-five years of age without
obvious physical disability which is disqualifying and
with not more than three dependents in addition to self
(Class II of the Volunteer Medical Service Corps) will be
the next to be called upon for active military or naval
service.
(d) The next group advised to enroll for active duty
with the Army, Navy, or Public Health Service (Class
III), will be the physicians under fifty years of age who
are without obvious physical disabilities which are dis-
qualifying and with not more than three dependents in
addition to self.
The exceptions in the groups of physicians are
as follows: (a) those essential to communities;
(b) those essential to institutions (medical
schools and hospitals) ; (c) those essential to
health departments; (d) those essential to indus-
tral Governing Board on recommendation of rep-
visory boards.
The exceptions will be determined:
(a) Essential to Coimmuiities. — Essential
community need will be determined by the Cen-
tral Governing Board on recommendation of rep-
resentatives of the Central Governing Board ap-
pointed by the Central Governing Board to make
a survey of local conditions.
(b) Essential to Institutions. — Essential in-
stitutional need will be established after confer-
ence between representatives of the Central Gov-
erning Board of the Volunteer Medical Service
Corps and representatives appointed by the gov-
erning bodies of the institutions concerned.
(c) Essential to Health Departments: — Essen-
tial health department need will be determined
after conference between representatives of the
Central Governing Board, Volunteer Medical
Service Corps, and representatives of health de-
partments.
(d) Essential to Industries. — Essential indus-
trial need will be determined after conference
between representatives of the Central Govern-
ing Board, Volunteer Medical Service Corps, and
accredited representatives of industries involved.
(c) Essential to Local and Medical Adrisory
Boards. — Essential local and medical advisory
board needs will be determined after conferences
between representatives of the Central Governing
Board, Volunteer Medical Service Corps, and rep-
resentatives of the Provost Marshal General's
Office.
Physicians not classified for actual military or
naval service may, when emergency arises, be
called upon to perform duties in accordance with
their qualifications and merits, indicated by in-
formation contained in their application blanks.
Those to be called for this service comprise: (a)
Physicians over fifty-five years of age ; (b) physi-
cians with obvious physical disabilities which are
disqualifying; (c) those rejected for all govern-
ment service because of physical disability; (d)
women physicians.
Some of this last group may be called upon to
supplement their private practices by performing
part-time service to meet community needs hith-
erto performed by men called to active duty. A
large number now engaged in home duties, but
THE MODERN HOSPITAL
277
who have agreed to do work of any kind, any-
where, upon request of the Central Governing
Board, will as the emergency arises be assigned
to duty in the following places: (1) local and
medical advisory boards; (2) institutions (med-
ical schools and hospitals) : (3) industrial plants;
(4) health departments ; (5) communities lacking
medical service.
While under the selective service law individ-
uals in the draft age are registered and inducted
into the service as privates, the Volunteer Med-
ical Service Corps enrolls and classifies individ-
uals as prospective commissioned officers, and
will assist in establishing the individual's status
when he requests transfer from the enlisted forces
to the commissioned branches of the service. En-
rollment in this corps definitely registers the phy-
sician as a patriot and provides definite govern-
mental recognition of his willingness to serve.
The Volunteer Medical Service Coi-ps is
exactly what its name indicates. It is a gen-
tleman's agreement on the part of the civilian
doctors of the United States who have not yet
been honored by commissions in the Army or
Na\T, or enrolled in the Public Health Service,
and a representative board of governors consist-
ing of government officials associated with lay
members of the profession, in which the civilian
physician agrees to offer his services to the gov-
ernment if requested to do so by the Central Gov-
erning Board. This Central Governing Board
consists of twenty-five men, the personnel being:
Surgeon General William C. Gorgas, U.S. A.
Surgeon General William C. Braisted, U. S. N.
Surgeon General Rupert Blue, U. S. P. H. S.
Provost Marshal General E. H. Crowder.
Dr. Franklin Martin, Chairman of Committee
on Medicine and Sanitation, Council of National
Defense.
Dr. Edward P. Davis, President, Volunteer
Medical Service Corps.
Dr. John D. McLean, Vice-President.
Dr. Charles E. Sawyer, Secretary.
Admiral Gary T. Grayson, U. S. N.
Dr. F. F. Simpson.
Dr. Frank Billings.
Dr. H. D. Arnold.
Mr. W. Frank Persons — Red Cross.
Dr. Victor C. Vaughan.
Dr. William H. Welch.
Dr. Robert L. Dickinson, Chief of Staff's Office.
Colonel R. B. Miller, U. S. A., Chief of Person-
nel Division.
Surgeon R. C. Ramsdell, U. S. N., Chief of Per-
sonnel Division.
Colonel James S. Easby-Smith, Executive
Officer.
Dr. Joseph Schereschewsky, Assistant Surgeon
General (Per.sonnel).
Dr. C. H. Mayo or Dr. W. J. Mayo.
Dr. William Duffield Robinson.
Dr. George David Stewart.
Dr. Duncan Eve, Sr.
Dr. Emma Wheat Gillmore.
To cooperate with the Central Governing Board
in prosecuting all activities pertaining to the mo-
bilization and enrollment of members of the Vol-
unteer Medical Service Corps, an executive com-
mittee consisting of five or more members has
been chosen in each state, and a representative
designated for each county in every state. All
men appointed to state executive committees and
as county representatives are preferably over
fifty-five years of age. The Central Governing
Board receives and passes upon all appointments.
The state executive committees receive facts from
the county representatives and make recommen-
dations to the Central Governing Board. The
county representatives submit facts to the state
committees, according to advice from the Central
Governing Board or the state executive com-
mittees.
Following confirmation of the Central Gov-
erning Board by the Council of National Defense
on August 5, President Wilson was immediately
informed of the enlarged scope of the organiza-
tion, and of the fact that the reorganized Volun-
teer Medical Service Corps is to include all legally
qualified physicians holding the degree of Doctor
of Medicine from legally chartered medical
schools who are not already in a government
service, whereas, the original organization in-
cluded only physicians who because of overage,
physical disability, and other reasons, w'ere not
eligible for service m the Medical Reserve Corps
of the Army or Naval Reserve Force. The Presi-
dent replied :
My dear Dr. Martin:
I have received your letter of August 5, laying before
me the matured plan for the reorganized Volunteer Med-
ical Service Corps, of which you ask my approval. This
work was undertaken by you under the authority of the
Council of National Defense; it has had great success in
enrolling members of the medical profession throughout
the counti-y into a volunteer corps available to supply
the needs of the Army, Navy and Public Health Service.
In cooperation with the General Medical Board of the
Council of National Defense, the strong governing board
of the reorganized corps will be able to be of increasing
service, and through it the finely trained medical profes-
sion of the United States is not only made ready for
service in connection with the activities already men-
tioned, but the important work of the Provost Marshal
General's Office and the Red Cross will be aided and the
problems of the health of the civilian communities of the
United States assured consideration.
I am very happy to give my approval to the plans
which you have submitted, both because of the usefulness
of the Volunteer Medical Service Corps and also because
it gives me an opportunity to express to you, and
through you to the medical profession, my deep appre-
278
THE MODERN HOSPITAL
ciation of the splendid service which the whole profes-
sion has rendered to the nation with great enthusiasm
from the beginning of the present emergency.
The health of the Army and the Navy, the health ot
the country at large, is due to the cooperation which the
public authorities have had from the medical profession;
the spirit of sacrifice and service has been everywhere
present and the record of the mobilization of the many
forces of this great Republic will contain no case of
readier response or better service than that which the
physicians have rendered.
Cordially and faithfully yours,
WooDROw Wilson.
A special insignia consisting of a button has
been designed for tfie members of the corps.
Every physician in the United States should
enroll in the Volunteer Medical Service Corps bo-
cause :
(a) The unsurpassed record of volunteer en-
rollment for actual service on the part of the
medical profession must be maintained.
(b) The Army and Navy must not be ham-
pered for a moment for lack of doctors to care
for the sick and wounded boys fighting our bat-
tles at the front.
(c) The great industries furnishing materials
of war, employing thousands of patriotic work-
ers, must have medical service.
(d) The home folks, the old and the young
wearily waiting over here, must have doctors.
(e) Recording, classifying, and careful dis-
tribution and full utilization of our entire profes-
sion of medicine will, without hardship to anyone,
enable us to instantly supply all demands, and
our utmost resources will then be available to aid
in establishing a permanent peace that will for-
ever make this world a safe place in which women
and children may live — a peace in the negotiation
of which the enemies of civilization against which
we are fighting shall have no voice.
A WAR PROGRAM OF VITAL IMPORTANCE
The Work of the Section of Medical Industry, War Industries Board, in Supplying Medical
and Surgical Materials Necessary for Military and Civilian Requirements.
By LIEUT. COL. F. F. SIMPSON, M. C, N. A., Chief of Section of Medical Industry. War Industries Board.
I AM glad to have the opportunity of present-
ing to your readers a brief statement regard-
ing the activities of the Section of Medical In-
dustry, War Industries Board. The purposes are :
(a) To aid the War Industries Board to
make available for war purposes a full supply of
materials required for the military emergency.
(b) To insure an adequate supply of essen-
tial medical and surgical materials for indus-
trial and other civilian requirements (for hos-
pital, dispensary and home use).
(c) To assist in the conservation of medical
and surgical materials on shortage lists.
(d) To cooperate with other departments in
establishing appropriate preferential rating for
civilian as well as military medical needs.
(e) To furnish other sections of the War
Industries Boards, as well as other departments
of Government, with information regarding the
essential needs of civil and military medicine.
(f) To assist in every other way possible in
securing essential materials for the care of civil
and military population.
We feel that all who are interested in the wel-
fare of the nation should realize that the first and
imperative need of the hour is to render maximum
service to the striking force of the nation by sup-
plying what it requires; and second, with full
consideration for efficiency and for humanity, to
serve those who fall temporarily by the wayside
in civilian life as well.
It is vital that every man, woman and child
strive to the utmost to put the war program into
maximum efi'ect in a big unselfish way, even
though it means inconvenience, the use of substi-
tutes, etc. Each one must aid to the extent of ac-
tual sacrifice, with a full realization of the fact
that, parallel to the utilization of existing facili-
ties, there is a definite program to increase pro-
duction of materials and facilities of which there
is now some stringency.
Included in the constructive program are : —
(a) A proper rating of medical activities in
relation to such fundamental needs as
Power (fuel, machinery, etc.).
Transportation of essential commodities.
Securing essential materials, such as steel,
chemicals, etc.
(b) The rating of employees of hospitals and
of medical industry, according to their relative
importance in the war program.
In ascertaining the national needs of drugs,
medicines, and medical and surgical supplies, it is
our purpose to make inquiry regarding the prob-
able needs of hospitals for the next six months,
in order that the essential demands may be met as
fully as possible. In effecting such a comprehen-
sive program, it will not be possible to consider
minor individual problems, but our desire is to as-
sist in formulating principles and policies which
will produce a supply sufficient to meet the essen-
tial needs of civil as well as militarv medicine.
THE MODERN HOSPITAL
279
WAR-TIME HOSPITALS PRESENT IDEAL CONDITIONS FOR INVESTIGATION
Data Which Could Not Be Secured in Peace Time Are Now Possible Through Experi-
mentation—Result Should Show Itself in Better Hospital Planning and Construction-
Suggestions for Making Most of Present Opportunity
By T. J. VAN DER BENT, Architect, McKim, Mead & White, New York City
THOSE who are well informed about planning
and construction of permanent hospitals have
realized on various occasions how great is the
need of numerous data in respect to hospital fea-
tures, equipment, and plan, each in reference to
their being beneficial or harmful to patients or
management. They also know that there is a
great variety of opinion as to the layout, the
details and plans, and a still greater variety in
regard to many questions concerning equipment
and mechanical installations. This difference of
opinion leads to a large amount of happy-go-
lucky hospital planning and construction. It is
the natural outcome of a situation where lack of
knowledge or lack of data to defend and sustain
opinions has given opportunity to the domination
of individual conjectures which are sometimes
guesses and at other timies "hunches," and which
would have very little or no influence if judgment
could be based on actual facts. To obtain facts
or even to indicate probabilities, it is necessaiy to
make a large number of experiments and observa-
tions, deriving conclusions only from the outcome
or result in the great majority of cases. For
various reasons these necessary experiments and
observations cannot, unfortunately, be made in
the permanent hospital of peace time. In the first
place, these permanent hospitals are constructed
and planned after a fairly well-decided pattei-n
and according to a number of fixed rules, although
it may be true that several of these fixed rules
have been adopted without proof or foundation
and have been simply absorbed as dogma. The
val'iety of opinion among eminent men of the
medical profession will be sufficient proof for this
statement. The second difficulty met with is that
the world at large would not concede the right of
making such experiments to the hospital physi-
cians. It would be considered criminal neglect if
some patients, for the sake of comparison of re-
sults, were placed in less advantageous positions
in respect to ward conditions, or in rooms where
conditions were not considered the best. If it
were desired, for instance, to obtain certain data
in connection with the influence of mechanical
ventilation, it would be necessary to place patients
in wards of various sizes, with diflferent exposures,
different locations or distribution of windows, and
different heating systems with or vvithout me-
chanical ventilation. Observations would have to
be made with different room temperatures, and
these observations should be considered during
long periods in winter and summer. It is obvious
that only few laymen would consider it proper
that Ruch experiments be made in the i-egular hos-
pital, and it is even questionable whether the law
would permit them.
The third and most serious diflSculty in obtain-
ing valuable data in the permanent hospital dur-
ing peace times is the lack of identical cases and
lack of variety in conditions.
If certain laws are to be derived from observa-
tions, if the reliability of certain data is to be
established, chance must be eliminated, and this
can be possible only when observations are re-
corded in a very large number of identical cases
(patients suffering from the same disease or ail-
ment to a fairly equal degree). Even in the
largest general hospital the greatest number of
identical cases treated at one and the same time
is still very small, and in the regular course of
treatment these cases would be subjected to the
same exposures and influences. Consequently,
there would not be opportunity to make compari-
son for diff'erent situations.
If hospital construction and planning must con-
tinue after this war in the same manner as it has
before, there will be little or no progress, and the
time is near when there will be a decided turn in
the wrong direction, if it has not already taken
place. At present we continue to build without
knowledge, on the strength of the private opinions
of a fev,- well-known men — opinions which have
in many instances no semblance of support or no
proof of being correct.
For the proper illustration of this situation let
one example be considered here, viz., the question
of mechanical ventilation. It is well known that
for many years there has been a great variety of
opinion as to the real value of mechanical ventila-
tion. Many men of eminence have defended it
as absolutely necessary; other men with equal
knowledge and capabilities have strongly opposed
it, and have stubbornly maintained that window
ventilation (natural ventilation) is the only cor-
rect system. In the majority of modern hospitals,
plants for the mechanical ventilating method have
been installed at great cost, but in the greater
number of instances these plants have been aban-
doned and are not in operation. This v/as brought
280
THE MODERN HOSPITAL
about through (1) the great operating cost and
the attempt to save for other purposes by not
running the plant; (2) adverse opinions of in-
fluential men connected with the institution; (3)
neglect and ignorance of the engineering staff.
There are no definite proofs as yet which justify
opinions for or against mechanical ventilation.
The only method of obtaining proof is by careful,
methodical, and continued experimentation. It is
conceivable that from numerous records of e.xpe-
riments, proof can eventually be obtained that
mechanical ventilation is of no value, or perhaps
even worse — that it is harmful. But it is also pos-
sible that the reverse will be proved and that me-
chanical ventilation will show itself of decided
advantage in the treatment of patients. This may
not be conclusively established for all cases, but
perhaps for a great many.
More through the accidental witnessing of ex-
treme conditions than for any other reason, I
would lean to the expectation of the last-men-
tioned result. If by various reliable experiments
and the records derived therefrom it were proved
that mechanical ventilation is of no value or
harmful, I would cheerfully join the great number
of men interested in hospital work, planning and
construction, to write a fitting epitaph and to dis-
miss forever this subject of great discord. This
subject can not and will not he disposed of by
dogma which is in many instances preached by
men who have not the slightest knowledge of the
working of mechanical ventilation or of its pos-
sibilities, or of the scientific and unassailable laws
upon which it has been conceived. Its actual value
will be established by experiment only.
There are many more questions pertaining to
planning, construction and equipment of hospitals
to be settled which are as important or even more
important. The example of mechanical ventila-
tion was mentioned only on account of the regret-
table and fruitless controversies in connection
with this subject which have been sowing seeds
of discord among professional men to the disad-
vantage of a great number of institutions, espe-
cially hospitals. It is of great value to obtain
definite information about arrangement of beds
in hospital wards, windov,- spacings, general heat-
ing system, height of ceilings, width of wards,
number and rows of beds, and many other items.
For a positive decision we can look only to the
war hospital, and especially to the temporary and
emergency hospital type. If the permanent hos-
pital of ordinary times is an institution where
experiments involving patients are difficult at all
times, in most cases impossible or impractical, the
war hospital presents a different situation. ' On
account of emergency, a variety of conditions will
exist which can not be planned in a permanent
hospital. These varying conditions will pertain
to plan, construction, mechanical installation,
classification and grouping of similarly affected
patients, the placing together of a variety of
cases, etc. The comparative small variety of dis-
ease and ailments in the military hospitals, and
the naturally large number of similar, parallel or
identical cases thus placed at the disposal of
science, offers a field of comparison so large that
to conceive an idea of such opportunity in ordi-
nary times seems like expecting the impossible.
No matter to what extent hospitals of the future
may desire to proceed in the field of experimenta-
tion, the small number of identical cases will
limit, if not defeat, the expected result. The
great variety of conditions in the same group of
buildings, which places similarly affected patients
to numerous different exposures and influences,
beneficial or harmful as each case may prove, will
materially add to the advantage of observations
in the war hospitals.
If consideration of the subject leads to the con-
clusion that advantage must be taken of the
opportunity, the medical profession can, by ap-
pointing a small executive committee of good men,
derive ways and means to attain the object in
view. They will, of course, need first of all the
approval and support of the War Department, and
the Surgeon General. Means must be devised to
have the observations recorded in the simplest
manner, least interfering with the ordinary rou-
tine of the hospital. The correct form of the
schedule or chart of observations will be a decid-
ing factor in the minimizing of work and preven-
tion of duplication.
Among the subjects of experiment and obser-
vation, I respectfully suggest that some considera-
tion be given to the following, all of considerable
importance in hospital planning and construction :
1. Efl'ects of various temperatures in wards in
connection with various percentages of humidity.
2. Effects of various degrees of window ven-
tilation, not only as to cure and recovery, but also
as to form and percentage of complications, espe-
cially pneumonia.
3. Different ceiling heights.
4. Placing of beds in reference to windows;
distance from windows; single, double, three or
four rows of beds.
5. Systems of heating.
6. System of ventilation — degree of mechan-
ical ventilation or complete absence of same.
Especially valuable are observations during very
warm and very cold weather. The last are more
so while complete or nearly complete closing of
windows is apt to occur.
THE MODERN HOSPITAL
281
7. Air currents in wards of various sizes dur-
ing different weather conditions, especially hot
and severely cold weather.
8. Effect of single, double, and triple tran-
soms.
9. Effect of drafts.
If, for later comparisons, careful records of the
various conditions of rooms in which identical
cases are treated are kept, as well as a correct
record of the medical results, time of recovery,
etc., it must lead without doubt to a definite deci-
sion as to which of the room conditions, which
exposure or influence is the best, and which the
most harmful. The later study of the records
will definitely prove what before was hypothesis,
or dispi'ove faulty theories.
The enormou.s task already resting on the
shoulders of doctors, nurses, and managing staff
of the war hospital will exclude any but the sim-
plest system of recording and observation. The
suggestion which I here make of burdening these
sincere and hard workers with additional labor
and responsibility may meet with great opposi-
tion. Only after very cai-eful consideration have
I dared to broach this subject. Where, however,
an enormous field of observation and comparison
has been created by emergency or accident, not
to be duplicated at a later time by the most auto-
cratic powers nor vastest riches, shall we ignore
this opportunity? Shall we let it be lost to the
future, without taking some advantage of the
rare occasion?
LITTLE JOLRNEYS TO PLACES AND PEOPLE WORTH KNOWING
The Fifth Little Journey — To the George F. Geisin^er Memorial Hospital, Danville, Pa.
An Ideal Endowed Hospital in the Pennsylvania Hills,
Accomplishing Much for Its Community
By MARGARET J. ROBINSON, R.N., Field Editor, The Modern Hospital.
THE Geisinger Memorial is a beautiful hospital,
inside of it and outside of it and for miles
around it — beautiful, physically as well as men-
tally— beautifully built, and beautifully equipped
and beautifully sanitary. After all, the first thing
we know about a hospital is the hospital building
itself, its equipment and sanitation, its offices and
furnishings, its beds and its food. A hospital
might have a most admirable and ethical board
of trustees and staff' organization, but if it didn't
have good plumbing and good cooking and com-
fortable living quarters for its nurses it wouldn't
be a very good hospital or a very successful one.
Think of it, you city dwellers, who pay forty
or fifty dollars a week for a private room in a
New York or Chicago hospital — a room on a shaft,
perhaps, dingy with darkness and soot, and within
sound of the traffic ! Think of looking out of your
windows at the Pennsylvania hills, brilliant in the
sunlight or turning purple and black in the
shadows, and your nearer vision seeing an im-
maculate and beautifully furnished room, and all
for four dollars a day! The ward patient who
pays only one dollar and a half a day gets the
same wonderful hills to see and the same im-
maculate surroundings and intimate care.
The Geisinger Hospital has a wide porch and
colonial pillared entrance, and spacious entrance
hall. The walls are marble and highly polished
below, unspotted and unbroken enameled plaster
above. In the main hall hang two impressive por-
traits of the founders of the hospital, George F.
Geisinger and Abigail A. Geisinger, who gave the
institution as a memorial to her husband. The
hospital, when built three years ago, had a capac-
ity of seventy-five beds and cost $500,000. Mrs.
Geisinger has endowed it with a trust fund of
$1,000,000, only the interest of which may be used
for the maintenance of the institution. At the
right as you go in are the offices. They have
every equipment and a suflicient ofl^ce force to do
proper accounting and to make complete and sys-
tematic records. To the left of the hall are large
and beautifully furnished reception rooms, all of
which may be thrown into one room for meetings.
Wiring is provided here, and direct current for
projection apparatus.
At the end of the main corridor are large airy
wards and glass-inclosed heated sun-rooms. There
are eighteen private rooms in the building, several
of them having private baths. A complete and
satisfactory system of nurses' light signals is in
use; also a ticker signal system, much after the
fashion of the usual telegraphic instrument,
which calls the visiting staff and officers to the
telephone. All private rooms have telephones.
The hospital kitchens, nurses' and officers'
dining rooms, and the refrigerating rooms ai'e on
the third floor. They are all beautifully clean and
attractive and light and well ventilated. The
superintendent's suite is on the third floor also.
The operating rooms are very complete. They
are furnished throughout with everything that
could be bought to insure good surgical methods
282
THE MODERN HOSPITAL
Fig. 1. The Ge
Memorial Hospital, with a glii
of the hills beyond.
and standards of aseptic surgery. The rooms are
finished in white tile and Vermont marble. The
seats of the Mayo Ampitheater are cushioned, an
unusual concession to the comfort of visitors to
the operating rooms.
I noticed in passing through the building that
in each nurse's chart room, just in front of the
desk, was an open wall space where, through the
glass, the nurse sitting at the desk could see all
parts of the adjacent ward.
The nurses' home is just east of the main build-
ing. It has attractively furnished reception
rooms, writing room, and music room for the
nurses. Through the windows at the side one can
see the carefully rolled tennis courts. Most of
the nurses have their own individual rooms.
There is a beautiful suite for the superintendent
of nurses and pretty rooms for the supervisors, a
tea room for preparing light lunches, and good-
looking china to serve them in. The bathrooms
in the home are white-tiled, and have blue rugs.
The halls are wide, have polished walls, and are
carpeted with crimson velvet runner.
If all hospitals provided such quarters for do-
mestic help as those given to them in the Geisinger
Memorial Hospital, there would be less difficulty
in obtaining help and keeping it. The rooms are
so good that they stand out in sharp contrast with
the usual dark and dingy corners in which many
hospitals house their maids, and then wonder why
it is so hard to keep good domestic servants.
The effect of these proper living conditions is
noticeable throughout the building. Everything
is clean and orderly. You feel that the men and
maids employed take an interest in the place —
that they are part of the organization. They
were trim, neat, efficient-looking people, all of
them that I saw. The domestic help have their
own kitchen and serving room, where most of
their food is prepared and served hot and palata-
ble right to the tables of their dining room, which
is next to the kitchen.
The hospital has a complete small isolation
unit near the ambulance entrance. A large
Packard ambulance is used for the transportation
of patients.
The staff organization of the hospital has been
thoroughly standardized. Dr. Harold L. Foss, the
superintendent, is also the surgeon-in-chief. He
was formerly assistant at the Mayo Clinic at
Rochester, Minn., and has organized the work at
One of the l-eceptic
rif the Jirectr-
the Geisinger Hospital on the same basis of staff
organization and group diagnosis.
All the work of the hospital is done by a full-
time salaried staff of specialists, acting under the
direction of the superintendent and surgeon-in-
chief. This organization makes it impossible for
incompetent and inexperienced medical men to
experiment in the hospital.
It is commonly stated that it would be impos-
sible to keep a community hospital open unless
the administration admitted to its privileges any
man licensed to practice medicine in the state,
and that such a staff organization as that just
described, excluding local practitioners, would
antagonize the community to the hospital. The
answer is that the Geisinger Memorial Hospital,
THE MODERN HOSPITAL
283
which depends on a wide area of farming com-
munity for its patients, has outgrown its capacity
in three years, and is planning to build again.
The finance committee of the hospital and the
surgeon-in-chief meet each month at the hospital
to adjust outstanding bills. To this meeting for-
1 ^i!i JiaiAfcfk
with the
signal a
ately adjusted master clock,
and-out check systems.
mer patients or those responsible for their ac-
counts are invited. Notices like the following are
sent out :
The bill enclosed is your account with the hospital. All
bills are due on the first of the month after being pre-
sented and are to be paid at the office in the hospital.
The House Committee meets at the Hospital the second
Friday of each month (or oftener if required) at 7.30 in
the evening for the purpose of investigating complaints
and adjusting bills of patients, should such action be
found necessary.
The next meeting will be held Friday evening,
191— at 7:30 o'clock.
Please bring your bill.
I attended one of these meetings in the office of
the surgeon-in-chief. Several men appeared, most
of them unskilled laborers with families to sup-
port— not objects of charity but men who would
be thrown into debt by any accident or illness that
would bring financial obligation beyond the cost
of the barest necessities of life. Each case had
been investigated previously. Each man in turn
was courteously greeted and asked to sit down.
The first bill was for sixty-three dollars, and
the following dialogue took place:
"Are you working, John?"
"Yes, sir."
"Where are you working, and how much do
you get?"
"Eighteen dollars a week."
"How many children have you?"
"Three, sir."
"Have you laid anything by, or are you in
debt?"
"You can't help be in debt these days, the way
everything costs."
"We'll not add to your burden man ; the bill is
canceled. We'll send you a receipt."
"Thank you, sir." The voice was husky.
"Good-night."
The second case was that of a butcher's clerk,
getting ten dollars a week. This man has two
children, the oldest eight years old ; has no coal
in yet. Bill of twenty-five dollars canceled.
^T'^
m
1
f
1
II
P
t.-'^'N,
4
W^
.
,._» ^
^^^^^^K^^^
Fig. 5. A sunlit mountain-cooled sunparlor.
In the third case there was continued illness in
the family, and the wage-earner did not receive
sufficient to provide necessities. Bill of fifty dol-
lars i-educed by finance committee to twenty and
receipt in full sent.
I have tried to say something technical about
this strai's^ely human business meeting, but all
I can think of is this : God bless the woman who
made this thing possible, and the men who have
the understanding to carry out her purpose.
284
THE MODERN HOSPITAL
FROM OLR FIELD EDITORS' NOTEBOOKS
A Small Hospital With Ideal Natural Surroundings A Nurses' Training School Which is
an Integral Part of a University— A Hospital Mascot
Reid Memorial Hospital, Richmond, Ind.
The Reid Memorial Hospital owns fifty-five acres of
land, lawn, and vegetable gai'dens, woods and rocky paths
and ravines. The nui-ses' home connects with the main
hospital building by a covered passageway opening out of
the first-floor sun parlor. The nurses' home is an old
residence, one with big i-oomy bedrooms and fine old wood-
work and staircases. The trees are so thick
around the house and so close to the win-
dows of the bedrooms that the bird choi'us
wakes the nurses up early in the morning. .;
The sleeping porch is over a deep wooded
ravine. At this time of year the nurses are
enjoying summer resort privileges.
The hospital boasts of a unique entrance
hall decoration — a wonderful vase about six
feet high, the cost of which would equip a
much-needed pathological laboratory.
The woman's auxiliary of the hospital is
a very live and active one. The ladies fur-
nish linens and supplies whenever needed.
Their meetings ai-e well attended and are
working meetings, where linens in plentiful
amount are made for hospital use.
The nursing education given at this hos- ^.^ , ^ ^..^^^
pital compares more than favorably with
that given by much larger and supposedly better hospitals.
A thorough curriculum is carried out and demonstration
classes are followed. The nurses leaving this training
for support. Its rates for the care of patients are sur-
prisingly low at this time when unusual conditions have
made per capita cost so high. In fact, in spite of the
excellent business management of the superintendent, Miss
Clara Pound, these low I'ates leave no margin for the
necessary growth of the hospital.
The Reid Memorial Hospital lies in most picturesque
nf Reid Memoiial Hospital showing
of the beautiful i
undings.
Entrance hall at Reid Memorial Hospital.
school have the best education that the supervisors of
this hospital can give them with the means at hand.
The hospital has very little endowment or public funds
and beautiful setting. Its nursing education is of the
best. It has human atmosphere and kindly care to the
sick and a splendid force of women in charge of it. It is
unfortunate that this hospital has not
more modern scientific equipment for
diagnosis.
The American Hospital, Chicago
The American Hospital stai'ted its
career some years ago in a small and
poorly equipped building. Even then it
began to prove itself one of the Good Sa-
maritans, and gave free bed care to many
who could not afford to pay for the care
they needed.
Through several years of struggle and
evolution toward better things, it has kept
its courage and its charity, and now can
boast of its new well-finished building,
having all means to make scientific di-
agnosis and giving the best nursing care
to its patients.
Dr. Max Thorek, the chief surgeon, who
has given some of the best years of his
life to the building of the hospital, plans
to make the hospital standard in every
way, and to give the best of nursing edu-
cation to the young women who come
there for a nurse's training.
A more complete description of the
work of the American Hospital will be
given in a later number.
Hackley Hospital, Muskegon, Mich.
The name Hackley, in Muskegon, is synonymous with
philanthropy. Charles H. Hackley, one of the pioneer
lumbermen of the state of Michigan, made millions in the
tly vase.
THE MODERN HOSPITAL
285
timber of the early days, and then had enough love and
faith for his own city to finance its industries after the
lumber boom died down, and to give it four and a half
millions for the public welfare, in a library and art gal-
lery, parks and educational funds, a manual training
school and an endowed hospital.
This hospital some few years ago was named as the
ideal small endowed hospital and Johns Hopkins as the
ideal large endowed institution of the country.
The hospital was opened for patients, November 17,
1904. It is built in the midst of four city blocks of
ground and its lawns and gardens have been for years the
Fig. 3. The Amer
HosFital, Chicago, with the
ch laboratory
pride of that part of the state. It was originally to be
a 50-bed hospital, but with administration facilities to
account for its ultimate growth. At present it has a
capacity for 100 patients.
During the last year a new and adequate nurses' home
has been built. A depai'tment for pediatrics is being con-
structed, and new and complete radiogi'aphic and patho-
logical laboratories have recently been installed. A new
obstetrical pavilion is also planned, as this branch of the
hospital's work has so far outgrown its capacity to
handle it.
The day that I visited Hackley Hospital, Miss Grace
McElderry, the superintendent, sent for the hospital mas-
cot, Joe. Joe is a part of the hospital. He was born
there, and his mother died there two weeks later of tu-
berculosis. He is three and a half years old now. He
was born a poor scrawny wisp of a baby that didn't seem
to have any chance at all, but by the combined efforts of
most of the doctors of the staff, the hospital officers and
the nurses, Joe now is as sturdy a little chap as you would
like to see, and he belongs to everybody. Evei-ybody con-
cerned is also determined that he shall not go back to a
foreign tenement house environment if they can help it.
Joe has his place at the table in the officers' dining room.
He calls the superintendent "Dama," the assistant super-
intendent. Miss Gray, he calls his "Dray," and when the
women visitors or the officers of the hospital go out of
the door or into the elevator he opens the door for them
and says "Ladies first, please."
I quite agreed with them that if there was a way to
do it, Joe should stay where he is and be made a doctor.
He has had three and a half years' start on his education,
and his life and his future could not be in better hands.
Robert \V. Long Hospital, Indianapolis
The Robert W. Long Hospital is a part of the Indiana
University School of Medicine, and is under the control
of the educational committee of the school. The training
school for nurses is one of the few in this country which
is an integral part of a university.
The training-school course is for three years. Students
who have completed three years' work in an acceptable
college are given eight months' credit towards a diploma
of the school, and a combination course is offered whereby
students are given credits toward a degree for the train-
ing-school course taken. The nurses in the Robert W.
Long Hospital work on the eight-hour schedule — eight
hours on week days and six hours on Sunday.
The hospital is a splendid building of solid steel con-
struction and dignified architecture, fitting in well with
the university atmosphere. The system of units of service
is well planned. Each department centers about a large
Figr. 4. Hackley Hospital, Muskegon. Mich., an ideal small endowed
hospital.
hall. All wards and service rooms open on this center of
administration. Each unit has its own convalescent din-
ing room. All the rooms are light and well ventilated.
A complete dispensary and social service department is
maintained in connection with the university. The stu-
dents of sociology cooperate with the out-patient service
and the follow-up work.
The Robert W. Long Hospital offers to students in the
University School of Medicine exceptional opportunity for
clinical material and study of social problems and to
nurses, exceptional opportunities for advanced education.
Elm City Hospital, New Haven, Conn.
Elm City Hospital in New Haven, Conn., is a private
hospital which gives high-grade service to the patients of
a group of surgeons and physicians well known in that
city, most of whom are on the staffs of the larger public
hospitals. It has a sixty-bed capacity and employs gradu-
ate nurses only.
The hospital cares for a large number of surgical cases,
but is especially equipped for the treatment advised by
the specialists in internal medicine. This department is
in charge of Dr. Robert E. Peck, an internist and neu-
rologist of New Haven, and has facilities for hydrothera-
peutic and electropeutic treatment and various forms of
massage and light therapy. The dietetic department pays
special attention to diet in disease.
286
THE MODERN HOSPITAL
CTTxe
MODEMM HOSPITAL
EDITORIAL AND PUBLICATION OFFICE.
58 East Washington Street, Chicago.
EDITORS.
altii
Henry M. Hurd .... Fidelity Building.
Frederic A. Washburn . Mass. General Hospital, Boston
Winford H. Smith . Johns Hopkins Hospital, Baltimore
S. S. Goldwater . . . Mt. Sinai Hospital. New York
W. L. Babcock Grace Hospital, Detroit
John A. Hornsby . 58 East Washington Street, Chicago
MANAGING EDITOR.
M. K. Chapin . . 58 East Washington Street, Chicago
SUBSCRIPTION.
Domestic postage, $3.00. Foreign postage, $3.50 I'lS
Shillings). Single copies, 35 cents.
Domestic rates include United States, Cuba, Mexico,
Porto Rico, Canal Zone, Hawaii, and Philippines.
Contributors, subscribers, and readers will find im-
portant information on advertising page 42.
OZ5G
The American Hospital Association Meeting
Owing to unavoidable conditions of publication,
this portion of The Modern Hospital will have
been printed before the Atlantic City meeting
takes place. An account of the meeting with
comment on the events will be found on page
310 and following pages.
The Fourth Liberty Loan
At the present writing, the American nation
has great cause to .join with our allies in thank-
fulness for the triumphs of our armies on the
western front. We have indeed justification for
an optimistic feeling that our war-weary world is
reaching the goal where lies the full contentment
of a lasting peace — a peace for ourselves and all
posterity. Yet optimism alone will not win.
By the time this issue of The Modern Hos-
pital is in the hands of its readers, the country
will have once more been asked to lend its aid
yet again, and give its patriotic support in suc-
cessfully raising the sum of six billion dollars,
for which amount the Fourth Liberty Loan will
call. No appeal for past liberty loans has gone
by unheeded, and with victory clearer and nearer
in sight than at any other period of the war, it
behooves all, high and low, rich and poor, to
dedicate the full strength of their resources to
the cause for which this loan is called. The gov-
ernment is not asking the loan of any one's money
without full remuneration for its use ; it is merely
asking a loan, guaranteeing to the lender a safe
and sure return of his or her money, together
with a full and fair interest. The moneyed
man has no preference over the person with
meager means ; all share alike for each dol-
lar that is invested. For the person who has a
small sum to invest, it is the means of a secure
investment with a certain return of interest; for
the man who has large sums at his disposal, un-
certain in these days of fluctuation in stock val-
ues, and who is desirous of obtaining the use of
his money whenever an urgent need demands, no
better solution to such a problem presents itself
than the investment in Liberty bonds. No sane
person will turn down a security backed by the
greatest government of all times.
The hospitals have already done, and are still
doing, their part in response to the call made on
their resources, both from a standpoint of
humanity and financial aid. This call will also
come to them, giving them another chance to
make shine with a still brighter luster the glory
that is already theirs. The Modern Hospital
bespeaks for all hospitals and allied institutions,
from the highest official to the lowliest, a ready
and eager answer to this call. Benefactors will
be able to satisfy at once both patriotic and char-
itable impulses by making their gifts to hospitals
in the form of Libertv bonds.
A Message From Belgium
Among the distinguished foreigners whom this
country had the honor of entertaining during the
last meeting of the American Medical Association
was a member of the Mission on Industrial Man-
agement, Belgian Ministry of Reconstruction,
Captain Dr. Rene Sand.
One of the editors of this journal asked Cap-
tain Sand, during his visit here: "How may
America best pay her share of the debt of grati-
tude which the whole civilized world owes to that
heroic and undaunted little country? What can
we best do to help Belgium after the war?"
Captain Sand very kindly promised to prepare
an answer to this question, for presentation
through the columns of The Modern Hospital,
and we have the privilege of publishing that an-
swer among our leading articles this month.
The first few months of peace. Captain Sand
says, will be decisive of the fate of Belgium — and
perhaps, by the way, the same might be said of
other nations that have not had to endure Bel-
gium's martyrdom. That stricken country will
need material help, personal help, and advice.
THE MODERN HOSPITAL
287
Almost all the social problems which are con-
stantly present everywhere — infant mortality,
bad housing, occupational hazards, tuberculosis,
alcohol, venereal diseases — will present them-
selves for solution in their most acute forms.
Yet, as Captain Sand very truly suggests, in the
heart of this desolation lies an almost unparal-
leled opportunity, for seldom or never has a
nation, having seen its ancient civilization shat-
tered to bits by a vandal invader, found the will
and the way to remold that civilization nearer to
the heart's desire. To assist the indomitable little
Belgian nation in establishing itself on a higher
level than ever before should be for this country
a high privilege.
A permanent American foundation in Belgium,
to foster research, to offer information on recon-
struction problems, and to maintain an educa-
tional campaign for raising the standards of life
in Belgium, would, in Captain Sand's opinion, be
the ideal means of serving his country and of
strengthening the bonds of friendship between
Belgium and America. We forbear to quote here
the graceful compliments which he pays to the
genius and generosity of this country ; but we
heartily commend his suggestions to the consid-
eration of our public-spirited fellow-countrymen.
The Volunteer Medical Service Corps
On another page we publish a statement by Dr.
Franklin Martin on the subject of the reorganized
Volunteer Medical Service Corps. The plan,
which has President Wilson's approval, makes
eligible to membership in the corps all legally
qualified physicians in the United States (includ-
ing women, but excepting physicians already in
government service), without regard to age or
physical disability. The blank to be filled out will
supply exceedingly complete data in regard to the
qualifications of each applicant ; in fact, the value
of such a collection of statistics in regard to the
medical profession of the country can scarcely be
overestimated. Members will be entitled to wear
insignia indicating their willingness to serve the
government, which they will have manifested by
subscribing to the following pledge : "I pledge
myself to abide by the rules and regulations of
the corps ; to apply for a commission in the Medi-
cal Reserve Corps of the Army, the Naval
Reserve P'orce, or for appointment in the Public
Health Service when called upon to do so by the
Central Governing Board; and to comply with
any request for service made by the Central Gov-
erning Board."
The organization gives control to a central gov-
erning board of twenty-five members, appointed.
with the approval of the President of the United
States, by the Council of National Defense, and
the affairs of the corps will be conducted from
general headquarters at Washington. P'orty-nine
state governing boards and state executive com-
mittees are provided for. The members of the
former consist of the members of the state com-
mittees of the Medical Section of the Council of
National Defense, while the latter are to be nomi-
nated by the state boards from among their own
members. County "representatives" for each
county of fifty thousand population or under
(with additional "representatives," in larger
counties, for each additional fifty thousand popu-
lation or fraction thereof) are to be nominated
by the state executive committee. The duties of
the state governing boards, however, are merely
"to receive facts from county representatives and
make representations to Central Governing
Board," while those of county "representatives"
are "to submit facts to State committees accord-
ing to advice from Central Governing Board or
State Executive committees." The purpose and
scope are defined as follows : "Volunteer Medical
Service Corps organization: (1) provides means
for obtaining quickly volunteer men and women
for any service required; (2) furnishes recom-
mendations and necessaiy credentials to assure
the best of medical service, both military and
civil; (3) determines beyond question the attitude
of the individual toward the war." The object
of the corps is stated to be " (1) placing on record
all medical men and women in the United States;
(2) aiding Army, Navy and Public Health Serv-
ice in supplying war medical needs; (3) provid-
ing the best civilian medical service possible ;
(4) giving recognition to all who record them-
selves in Army, Navy, Public Health activities or
civilian service."
The scheme is a masterly one, and the service
to be performed by such an organization is indis-
pensable to a true war conservation program. In
view of the acute need of using the medical re-
sources of the country as wisely and economically
as possible, it is clearly of the first importance to
find out exactly what those resources are, and to
secure the cooperation of physicians in applying
their services where they will do the most good.
Just as clearly is it the patriotic duty of all physi-
cians to place themselves on record and at the
disposal of the national government.
Yet those who study the form of organization
of the Volunteer Medical Service Corps may not
be able to refrain from wishing that so fine and
sweeping a vision had included a little deeper
view into the future. That the medical profes-
sion will relapse at the end of the war into the
288
THE MODERN HOSPITAL
unregulated individualism of ante-bellum days is
scarcely conceivable. In the better-organized
world which, we must believe, is going to emerge
from the floods of the present disaster, physi-
cians, like other men and women, will have to
sacrifice something of individual caprice and
privilege for the benefits of a more solid and
stable order of things. What a splendid founda-
tion a Volunteer Medical Service Corps would
have made for the future organization of the
medical profession ! Indeed, although the organ-
ization is, of course, created to meet war condi-
tions, we find no provision for disbanding at the
close of the war, nor is it imaginable, if the plan
.succeeds, that what has been accomplished at
such cost will be thrown away at the coming of
peace. The very records of the organization will
be of immense value — and a lever of tremendous
power in the hands of those who have learned to
use them. That the Volunteer Medical Service
Corps will dissolve and, like the baseless fabric of
a vision, "leave not a rack behind," is scarcely
conceivable. It is hoped that in due time a way
will be provided for a transition from the present
purely autocratic military form of control by
officers appointed from outside of the organiza-
tion, to the representative form of govei'nment
which will, of course, be demanded when war is
over. The pledge of the candidate "to comply
with any I'equest for service made by the Central
Governing Board," of course, lodges in the hands
of that board an immense power. Only the exi-
gencies of war could justify such a pledge, par-
ticularly when made to a board which is not
responsible to the governed body.
We believe that this power will be exercised
wisely and well by the present Central Govern-
ing Board. We also think that medical men can
not think too soon or too seriously about what is
to be the final issue. Meanwhile, as we have said,
it is the duty of all medical men and women to
place themselves at the nation's service, and all
patriotically guided hospitals will see that the
matter is placed with proper emphasis before
the members of their respective medical staflfs.
An Appeal for Nurses From the Red Cross De-
partment of Nursing
From the Department of Nursing of the Ameri-
can Red Cross at Washington comes the follow-
ing appeal to the physicians of America :
Surgeon General Gorgas has called for a thousand grad-
uate nurses a week— eight thousand by October 1. Twen-
ty-five thousand graduate nurses must be in war service
by January 1— in the Army Nurse Corps, in the Navy
Nurse Corps, in the U. S. Public Health Service, in Red
Cross war nursing. This involves withdrawal of many
nurses from civilian practice and necessitates strict econ-
omy in the use of all who remain in the communities.
You can help get these nurses for our sick and wounded
men by: — Bringing this need to the attention of nurses;
relieving nurses where possible wholly or in part from
oflice duty; seeing to it that nurses are employed only
in cases requiring skilled attendance; insisting that nurses
be released as soon as need for their professional service
is ended; seeing that your patients use hospitals instead
of monopolizing the entire time of a single nurse; encour-
aging people to employ public health nurses; instructing
women in the care of the sick; inducing high school and
college graduates to enter the Army School of Nursing
or some other recognized training school for nurses.
Encouraging nurses to go to the front involves real per-
sonal sacrifice and added work on the part of the physi-
cians whose duty it is to maintain the health of our
civilian second line of defense — but the men who are fight-
ing for their country in France need the nurses.
A Well-Directed Oifensive Against Political Job-
bery in State Institutions
The executive committee of the New Jersey
State Hospital recently adopted a motion recom-
mending to the State Board of Charities and Cor-
rections of the State of New Jersey the adoption
of a rule that in the future only medical men may
be employed as chief executive officers of state
hospitals for the insane, special institutions for
the feeble-minded and for the state epileptic vil-
lage. In some of these institutions responsibility
for management has been divided between a lay
superintendent and a medical director, causing
more or less friction, according to the committee,
and this dual control is characterized in the reso-
lution as "illegal and just as unwise and impos-
sible in the management of institutions as it is in
business enterprises." It is also urged that in
choosing chief executive officers, medical direct-
ors, first assistants, and other physicians holding
positions of similar responsibility, the local boards
of managers of the state institutions be required
to confine their choice to those who have had medi-
cal and psychiatric training and experience suf-
ficient to qualify them as leaders of their profes-
sion, who are fully abreast of the times, who
posssess a first-hand acquaintance with all the
latest methods, procedure, and discoveries in the
field of medicine, neurology, and psychiatry, and
who have, in addition, administrative qualifica-
tions of a high order.
It has long been one of the crying scandals of
the hospital field that it was possible for state '
and city administrations to make appointments
to the supervising positions in state institutions
without regard to the qualifications of the appli-
cant to fill these positions of responsibility in the
care of the mentally and physically ill.
Many of the so-called wardens or superintend-
ents of state institutions have brought with them
THE MODERN HOSPITAL
289
to their administrations only political power and
ability, which has been used often to pay political
debts or to line their own pockets, and officers of
a high grade of skill and conscience have fi'e-
quently been handicapped and humiliated by polit-
ical appointees who have no conception of the pro-
fessional side of hospital management.
If the State Board of Charities and Corrections
of the State of New Jersey make a ruling which
in future will form some control of this situation
they will have made creditable progress against
the political control of hospitals, and will have
established a precedent which will be an inspira-
tion to other politics-ridden states to follow.
The Increased Need for Care of the Public Health
We have in previous issues emphasized the need
for giving not less, but more, attention to the civil
hospitals during war than during peace. This
need is illustrated by the following extract from
a letter written by an officer of a small hospital
in an Atlantic seaboard state :
"Usually during the summer, people around
here are too busy to come to the hospital and are
up and down at home with a doctor in attendance.
This year, many of the doctors being in the serv-
ice, it is necessary to come to a hospital for treat-
ment, and this institution has been busier for the
past seven months than at any time before."
In one county in another southern Atlantic
state, before the war there were six doctors, or
one for every 673 persons. Two of these physi-
cians have already been commissioned, leaving
only four doctors for the whole county of 422
square miles ; and of these four one has written to
the state board of health stating that he is fre-
quently laid up with arthritis during the winter
and does not know how much he will be able to
do during the coming winter. From an Allegheny
. mountain county a physician writes to the medical
authorities of his state that he is now the only
physician in a wide area and that children are
dying for want of medical aid. In still another
community in the same state there were three
physicians before the war, one for each thirteen
hundred population, a much larger population
than one physician can adequately care for in
peace times. One of these three physicians has
been commissioned, leaving almost two thousand
persons for each physician to handle. (The fore-
going statements are drawn from a publication of
the School of Social Work and Public Health,
Richmond, Va., of which Dr. H. H. Hibbs, Jr.,
is director.)
An overburdened physician in one of our large
cities has said that the shortage of medical and
nursing care for the civilian population would
adjust itself if physicians and nurses would de-
vote themselves to patients who really need atten-
tion, leaving the hypochondriacs and the people
with trifling ills to find out that they can, if they
must, get along just as well without the sheer
luxury of medical and nursing care. No doubt,
some such taste of privation may be good for at
least a certain section of our overpampered urban
population ; but we must not forget that there are
other sections, especially in the rural districts, to
which sickness is not a luxury, but a grim and
deadly enemy. We must not forget the urgent
need of everything which may help the few doc-
tors who are left to care for the needs of this
deserving class. Public health nurses and com-
munity hospitals are not a luxury, but a necessity,
in these districts.
What Are Hospitals Doing to Conserve Food?
How much is your hospital doing in the way of
conservation of food materials? Can it be that
some of our institutions are taking unfair ad-
vantage of the leniency to hospitals? While it is
true that consideration for the sick is perfectly
justifiable, yet it is a little difficult for the layman
to understand why nurses, doctors, and employees
of a hospital should be given the same considera-
tion as patients.
Why, for instance, should hospitals be allowed
to use sugar and wheat bread in unlimited
amounts when every one in the country is asked
to limit the consumption? When private indi-
viduals and public eating places are abiding
strictly by the regulations of the Food Admin-
istration, it is a little disturbing to go into hos-
pital after hospital and find no restriction
whatever on the use of sugar by any employee or
resident and to find bread being wasted in large
quantities, nurse after nurse taking three or four
slices of bread from the plate, at least two of
which later come out of the dining room with the
soiled dishes and are thrown in the garbage. To
have a large pan of partly eaten rolls, made with-
out thought of substitute flour, come into the
kitchen every morning from a staff dining room
where twenty or twenty-five people are served,
seems little short of criminal.
The nurses and doctors in the operating room
of a certain hospital were having eggnogs made
of cream and certified milk during the whole sum-
mer, when fruit juices, iced tea sweetened with
maple sugar, or plain milk with wafers or sand-
wiche- might veiy well have been substituted.
The country has been asked to use beef sparing-
ly; yet we know at least one hospital which has
served steaks to every one, including wards and
290
THE MODERN HOSPITAL
employees, two and three times each week. These
are a few things actually occurring ; many others
might be added.
The foregoing is not intended to discredit the
excellent work in conservation done in many of
our institutions. It is merely an appeal for fair
play. Let it not be said that there are "slacker"
hospitals, which by their self-indulgence and
carelessness offset the best efforts of all the rest.
With so many of our nurses and doctors giving
everything in the service of our country should
we not be willing to give a little thought to the
same service in all our hospitals?
Another Staff Member Called for War Service
The Modern Hospital has been highly hon-
ored in the number of its staff members who have
been called to positions of responsibility created
by war conditions. To share, by giving up our
best, in the sacrifice that all are making, becomes,
under such circumstances, a privilege as well as
a duty. The most recent call for this philosophy
comes in connection with a request from the
American Red Cross in France that we lend the
services of our field editor. Miss Margaret J.
Robinson, as a technical writer on war hospitals
and hospital work in France. Our readers have
already had an opportunity to become well ac-
quainted with Miss Robinson's work, and will join
with us in wishing her, in this new literary field,
all the success which her exceptional qualifica-
tions undoubtedly assure her.
Who Are the Blind?
In the department devoted to Industrial Re-
habilitation of Disabled Soldiers and Sailors, Mrs.
Sidney McCallin desci'ibes a magnificent work — a
work without precedent — which is being done in
England for the blind soldiers and sailors of Great
Britain. Affectionate care and far-sighted intel-
ligence combine to restore to the blind man his
birthright of happiness and usefulness. Indeed,
according to Mrs. McCallin, the intensive train-
ing at St. Dunstan's often more than compensates
for the loss of sight. The men are not resigned,
but happy, and in many cases rendered more
efficient and valuable members of society than
they were before.
A magnificent work indeed! Let us rejoice that
a way has been found to pay a portion of the debt
that society owes to those who have hazarded in
its defense life and all that makes it sweet. Let
us in this country learn all we can of the methods
of this beneficent foundation, and apply them ac-
cording to the need which will soon arise.
Yet one thought rises unbidden. What kind of
civilization is it that makes it necessary for men
to lose a sense before they can have the training
that makes possible the attainment of greatest
happiness and usefulness? To lavish every care
on those who have broken and spent themselves
in our service is justice, not charity; but what a
commentary on our civilization is the fact that a
man must literally give his eyes to gain his full-
est development! How many wasted lives might
be saved if we only realized that the gi'eat work
of a civilized community is not making steel or
mining coal or raising wheat, but making human
beings happy and useful ! Are we the real blind ?
THE CIVIL HOSPITALS AND THE ARMY NURSING
SCHOOL
Hospital Conference of the City of New York Protests
Against Transfer of Senior Nurses to Army School
A letter from the office of the Surgeon Genei-al of
the United States Army suggesting that certain hospitals
transfer to the Army School of Nursing considerable
numbers of senior and possibly intermediate pupil nurses
has come to the notice of the Hospital Conference of the
City of New York, representing moi-e than forty hospitals
which conduct training schools for nurses. It is believed
that this letter was sent out through a misunderstanding,
for on June 1 the Secretary of War, in correspondence
with representatives of the American Hospital Associa-
tion, declared that "under no circumstances is the army
to call out the second- and third-year pupils; that would
be a body blow to the hospitals, and it is unnecessary."
The purpose of the Surgeon General's appeal appears
to be to meet the shortage of nurses in the army.
A careful analysis of the situation shows that the short-
age of nurses in the army can not be fully met in the
manner pi'oposed, and can not be even pai'tially met with-
out seriously impairing the efficiency of the civil hospitals,
not only in the care of their own sick, but in the train-
ing of nurses and hospital assistants for army purposes.
The hospitals of the City of New York greatly desire
to render adequate aid to the army in this emergency,
and have been informed that at a recent conference in
Washington at which the Surgeon Genei'ai's office was
amply and presumably authoritatively i-epresented, it was
decided to develop a program for the participation of the
civil hospitals in the training of pupil nurses and hospital
assistants (nurses' aids) in affiliation with the Army
Nursing School. The Hospital Conference is of the
opinion that such a program should be prepared im-
mediately by the Surgeon General's office in conjunction
with the representatives of the American Hospital As-
sociation, and should then be presented to the hospitals
of the entire country as a substitute for the makeshift
proposal above referred to.
On the completion and promulgation of an adequate '
and dependable program, calculated to meet the army's
nursing needs throughout the war, the Hosoital Confer-
ence will devote its best energies to the execution of such
a program, in loyal devotion to the government and in
hearty cooperation with the medical department of the
army. — Resolution adopted by the Hospital Conference
of the City of New York August 26, 1918.
THE MODERN HOSPITAL
291
OBSTETRICS AND THE HOSPH AL='
General Indifference to Obstetrics — Need for Skilled Care
and Hospital Facilities — Delivery Room as Impor-
tant as the Operating Room
Bv CHARLES E. rADDOCK. M. I) . Obstotiician.
St. Luke's Hospital. Chicaiio, lU.
The department of obstetrics has not developed as other
branches of medicine have. The reason is made plain if
we study past conditions, which allowed medical stndents
to graduate without ever having seen an obstetrical case,
and permitted ignorant women to act as midwives.
The law demands that a man or a woman must have
had three or four years of medical training and have re-
ceived a diploma before he is allowed even to WTite a
prescription for a dose of medicine; but to the midwife
who has the most limited preparation and scarcely any
education, the right is given to attend a woman in child-
birth. Fortunately this state of affairs gradually is being
changed, but not as yet changed enough for us to obtain
much benefit. It is because there is such indifference
to obstetrics that the laity are slow to accept new
methods, and physicians are content to go along doing
things in the same old way.
Some?iow we must be roused! For in the past twenty-
five years the mortality and the morbidity due to child-
birth have not much lessened and will not improve until
the department of obstetrics is placed upon a higher plane
of observance. A woman in labor may now be attended
by anyone, and during the delivery any place is good
enough for the patient. Every obstetrical case is a
surgical ease and the sooner that the fact is accepted by
all concerned, the better it will be for the mother and
the babe.
To operate upon a woman who has a small tumor of
the breast, a skilled physician surrounded by all the
modern conveniences of the hospital is demanded, while
the woman in labor is left at her home, where no pre-
tense at cleanliness is made. Perhaps she occupies a
room which recently has contained a contagious or septic
patient and is attended by the family physician, who must
of necessity neglect her because he has other patients
demanding his attention. Also the obstetrical case is
nursed by friends who are w-illing and loving but who are
entirely ignorant of the first principles of surgical cleanli-
ness. Is it any wonder, then, that our mortality and
morbidity are so great?
From the fundus of the uterus, down through the
gtenital tract, to and including the vulva, there is a
wound surface, toi-n, bruised, and bleeding. It is neces-
sary that this wound surface be protected from outside
contamination with pathogenic organisms. It is necessary
that tears be properly repaired, that the integrity of the
parts be maintained and that infection be prevented.
With these facts before us, why should the patient
with the small tumor be sent to a hospital and the woman
whose life is being jeopardized in childbirth be left at
home under unhygienic surroundings? There are rea-
sons that make such a practice possible. But I think
you will find the most telling reason to be sentiment —
for instance, either the father or mother or a dear rela-
tive was born in a certain home and the expected child
must, likewise, be born there. Besides, there is a tradi-
tional belief that "only paupers are bom in a hospital."
Added to sentiment and tradition, fear is another reason
frequently given for not going to the hospital to be con-
fined. Only recently I heard a fairly well educated
woman say "they" would strap her to a table with her feet
in the air. Another one kew that "they" would change
her child and give her the baby belonging to someone else.
Then there is the fear of the physician that his patient
may not get the proper attention because he is not a
member of the staff of that particular hospital. In the
latter case there may be some excuse for his concern.
Occasionally I have been obliged to attend a case in a
strange hospital, and I knew that my patient did not get
the attention she deserved because I was handicapped by
not knowing the nurses and the interns. With or with-
out foundation, there is no doubt that such impressions
often deter a physician from taking a case in labor to a
hospital. Sometimes a physician feels that his patient
is lost to him for future confinements if he sends her to a
hospital. For often the nurse tells the patient that she
has never heard of her doctor and that "Dr. So-and-so"
of "our hospital" is a much better man.
Then, financial reasons are frequently given for not
placing an obstetrical case in a hospital, and unless one
occupies a ward bed there must of necessity be more ex-
pense attached to the case than at home. But after all,
want of knowledge on the part of the patient, that the
hospital is the better place in which to give birth to her
baby, is one of the main reasons for so many deliveries
at home. More and more, however, women are seeking
the hospital for their confinements, and those of us who
are limiting our practice to obstetrics are seldom told by
the patient that she wishes to remain at home, but usually
are asked immediately what hospital we shall suggest.
Twenty years ago, one would rarely hear of a woman's
going voluntarily to the hospital to be delivered, but now
both the rich and the poor are making reservations there
weeks before the expected time. This fact shows that
the movement is growing; that people are becoming
more enlightened as to the benefits of such a proced'ire.
The physician who is doing careless obstetrics at the
home will do better work at the hospital because he
knows he is being watched by bright, active, young interns
and nurses. Yet not all the poor obstetrical work is done
at the home, because occasionally a physician whose work
is far from what it should be will become associated with
a hospital. This man, however, will not stay long. He
is soon found out.
One in a position to observe cannot help but be shocked
when he sees the inferior surgery that is being done at
the homes. Daily women in labor are brought to the
hospital in a mutilated condition, the babies still unborn.
but dead, killed by the brutal use of instruments. These
women and these babies are victims of poor obstetrics;
and we see only a very small fraction of such victims.
The family is frequently a disturbing element at a con-
finement because its mental attitude toward the physician,
who so frequently needs encouragement, is anything but
helpful. The demands by the family that something be
done to hasten the delivery often causes the physician to
interfere before he should, which results in injuries to
both mother and babe. But at a hospital there is not the
same opportunity for the husband to interfere, for there
the doctor, with the assistance of his nurses and interns,
who share his responsibihties, is able to leave the room
when he considers it necessary for the good of the patient.
Because hospital facilities are in themselves so valuable,
it is unfcirunate that these facilities are within the reach
of the few. And yet, as year by year, every little village
is building its hospital, it will not be long before these
facilities will be within the reach of all. And as capable
292
THE MODERN HOSPITAL
men and women are connected with these institutions, it
is no longer the rule for people to seek the larger cities
for experienced physicians and hospital advantages.
Those of us in the larger cities, who think we excel in
such blessings, might with profit study the work in some
of the rural hospitals. Obstetrics cannot be done in the
home, any more than abdominal surgery can be done
there. Neither, however, can obstetrics be done in a
hospital without a well-organized department. One is
as impossible as the other. The patient had better re-
main at home than to be cared for in a general hospital
with no special department of obstetrics.
So every hospital should have its maternity depart-
ment, which consists of surgeons, interns, and nurses
qualified for the work. At the head of the department
should be a well-trained graduate nurse in charge of all,
one who has had special training in a maternity hospital.
The hospital \vill protest that it cannot afford such
luxuries. But the time is coming when it must!
Aside from reasons of sanitation and safe delivery for
the mother, there is another reason why the hospital
should be selected as a proper place for confinement, and
that is the special interest of the infant. There frequently
comes a time in the delivery of a woman when it becomes
necessary for the physician to act promptly to save the
life of the babe. I am sure that almost any physician
■will say of some case or other, "Had I had my patient in
a hospital, I should not have lost the baby."
It has been a great source of satisfaction to me in tho
past few years to know that I have saved the lives of
many babies, because I had my patients in the hospital.
I know from experience that many of them would have
been sacrificed at the home. The physician watching at
the bedside of the woman in labor, frequently testing the
heart-beats of the unborn babe through the mother's
abdomen, occasionally notices that the life of the infant
is being jeopardized. He knows that there are only a
few minutes left to save the child. If his patient be at
her home, assistants must be sent for, arrangements for
the operation attended to and much time is lost. The
baby is sacrificed! In a hospital conditions are different.
Assistants are ready, the patient is quickly delivered, and
the baby saved.
Any case at any moment may become an emergency
case. With the most favorable prognosis, something may
suddenly develop that calls for the delivery. This is not
a dream but a fact! So serious a fact that in conclusion
I beg of the hospitals that they give as much attention to
the delivery room as to the operating room, and that
obstetrics be taken as seriously as a surgical operation
and treated in the same manner, and that the obstetrical
department be given all the skill, all the surgical cleanli-
ness of the surgical case. That it help us by its hearty
cooperation is my earnest appeal to the organization that
I have the pleasure of addressing this morning.
THE HOSPITAL— PAST, PRESENT, AND FUTURE*
A Patriotic Economy
When there are so many occasions for sacrifice, an ap-
peal to patriotism which Is also an appeal to self-interest
should certainly find no slackers. Such an appeal to the
hospitals of the country appears in this issue of The
Modern Hospital. This exceedingly practical set of rules
for the heating plants of small and large hospitals was pre-
pared at our request by the United States Fuel Adminis-
tration. If there were no war, these instructions would
still be most valuable, because their observance means
clear saving in fuel. As it is, they should be enthusiast-
ically welcomed by the hospitals of the country.
Changed Attitude of the Public Toward the Hospital —
Reasons for the Greater Confidence Felt in Hospitals
by the Public — Future of These Institutions
By a. S. MONRO, M.D., Major C. A. M. C, Director of The Vancouver
General Hospital, Vancouver, B. C.
It is within the memory of most of us, and I need not
go back more than two decades to recall the great change
that has taken place in public opinion towards the hos-
pital. Then it was a matter of life or death, such as a
severe accident or illness that required surgical treat-
ment, that compelled the unlucky one to be sent to
hospital. How the friends and neighbors talked about it
and commiserated with the relatives. Or perchance the
sick one had no home but belonged to the great army
who have no settled abode, and then of course the hospital
was the only place for him, but how he was pitied!
No self-respecting woman, however much she dreaded
the coming ordeal of maternity or the upsetting of her
household resultant upon its advent would entertain for a
moment the suggestion of going to the hospital. The
hospital was only for the outcast and the unfortunate.
To ask parents to place their children in the hospital
for the purpose of having, say, an operation for removal
of the tonsils done or any other common affection was
often sufficient to bring about an immediate change in
medical attendants, and the physician who had the
temerity to pi'opose such a thing became the subject of
adverse criticism by the community at large.
Public opinion, however, was not altogether wrong in
the attitude it assumed towards hospitals. The facilities
offered by many of them for the care of tiie sick were
no better or even as good as that approached by a well
appointed home. The accommodation in many institu-
tions provided only for the homeless, the unfortunates or
those who required a major surgical operation, and even
in the latter case, if the patient had a good home, every
effort was made to have the operation done there rather
than go to the dreaded hospital.
It was not uncommon in this city no longer than fifteen
years ago to see major operations performed at the home
of the patients. As for the minor ones, only the last five
years has seen them transferred from the home to the
hospital. What, then, has brought about this marvelous
change of opinion in the public mind towai-d the hospital?
The change is due to better service.
The factors most influential in molding public opinion
were :
1. Improved accommodation. This meant new build-
ings that provided for all classes of the community, the
private room, semiprivate and semipublic beds, and better
general wards. The hospital, no longer dull and dreary,
now took on the aspect of a comfortable home, and the
patient was made to feel his stay in the hospital would
be as pleasant as circumstances would permit. The
dietary is in the hands of a specially qualified dietitian,
and, when his condition permits the patient can have as
varied a meal as may be obtained in any well-appointed
restaurant.
2. Better nursing. Of more importance even than
accommodation is the quality of the nursing service pro-
vided. In this respect the public feels that a high estate
of efficiency has been reached in the nursing profession
and has shown its confidence by demanding not only in
the hospital but in the home the elimination of the un-
ntion of the Hospital of British Colum-
♦Paper read at the First Co
Ilia, June 26, 27, 28. 1918.
THE MODERN HOSPITAL
293
trained nurse. Some nurses are better adapted for cer-
tain work tlian others. In the hospital this specialization
of service is carried out to a lar,c:e extent, and the larger
the institution the greater the need of it with consequent
advantage to all concerned. The public understands and
appreciates the advantage of this.
3. Better scientific equipment. Advance in medical
and surgical science, requiring expensive equipment and
laboratory facilities only to be found in connection with
modern hospitals, has been an important factor in the
influencing of public opinion in favor of the hospital.
A hospital composed of buildings, beds, furniture, etc.,
and without up-to-date laboratories, x-ray departments,
and operating rooms, is nothing more than a glorified
boarding house. The public appreciates the value of
these essential featui'es in a hospital, and consequently
those who ai'e sick are not only willing but anxious to go
where the fullest facilities are offered for getting them
well. The people are learning that the essential prelimi-
nary to intelligent treatment is a correct diagnosis, and
in many cases it is necessary to go to the hospital to have
this made.
In the treatment of disease the use of medicine or the
knife is not the only means or even the most desirable in
many cases. We know that the x-ray, radium, electricity
in various forms, hydrotherapy, thermotherapy, and
massage are essential to successful results in the treat-
ment of many of the ailments. This demands an ex-
pensive and costly equipment, and the hospital is the
place to which the public looks to provide these facilities.
Above all, the motive animating those who are responsible
for the care of the sick from the hospital director down
to the humblest orderly is one of service. No hospital,
however well equipped and staffed, can do its best work
without this atmosphere of service mingled with a spirit of
kindliness and sympathy pervading the entire institution.
The future of the public hospital and the place it will
occupy in the esteem of the community in which it is
located will depend largely upon the quality of service it
can render to those who require it.
The system under which the public hospitals of British
Columbia are conducted offers, in my opinion, many
advantages over the purely municipal or civic control.
The remedy for a poor service in any community is
directly in the hands of the people in that community,
but at the same time a closer supervision by the state of
all hospitals would undoubtedly lead to a higher standard
of efficiency generally.
, The war has biought about so many radical changes
that state control of many of our most vital necessities is
now accepted by the public as a matter of course and with-
out question. Who will venture to predict the permanency
of these changes in the period after the war and what
will be their effect upon the relation of the hospital to
the community? A beneficent socialism that would pro-
vide, at the expense of the state, for the cai'e of all the
sick and injured is as yet too Utopian for realization, but
the trend of events are along these lines; witness the
British Medical Insui'ance Act.
In this young country, as well as in the older centers,
the hospital will be required to provide a larger and
better service, and it is not too much to say that the day
is not far distant when all but the minor and the most
trifling ailments will be cared for in the public hospital.
The advantages of such a system from an economic point
of view are manifest. The saving in time and cost alone
would be immense, to say nothing of the added gain to the
patient in being enabled to recover from his sickness in
the shortest possible time.
THK MEMOIRS OF A HEAD NURSE
V. — \n Officer and a Gentleman — A Little Lad of Eight
Who Proved That Blood Tells After All
This is a hospital story because it ends in a post hos-
pital, but, to have you really understand the Boy, I shall
have to begin before the hospital part of it.
He was about eight years old then, a strong strapping
little fellow with a soldierly body and a shock of brown
hair that would never stay brushed. He belonged to a
fine old family. His mother was a niece of one of the
admirals you had to learn about in United States history
when you were in the seventh grade, and his father came-
of a long line of army people. They had been army people
before '76 — the army was in their blood, so you can under-
stand why I am so sure of where he is now, if he is still
alive.
I was teaching in those days, and Webster, when I first
made his acquaintance, was a pupil of mine. I have never
forgotten the sterling character of the boy, his never-
failing respect and courtesy, and his genuine bravery. He
was an officer and a gentleman always.
He was terribly handicapped in the schoolroom by stut-
tering, but this was more than balanced by a ready wit
and keen intelligence. This story happened before the
"swat the fly" days, and one day during the class hour,
when we came to a story in the reader which pleaded with
children not to hurt or destroy anything that lived because
God had made it, Webster said, "That m-m-may be true
about fl-fl-flies, but you can never m-m-make me believe
that G-G-God made m-m-mosquitoes."
His father was a captain of artillery at the post, and
was going down fast, physically and mentally, from drink.
His mother, a gentlewoman to her finger-tips, too proud
to complain, endured constant humiliation in her own
home, and must have breathed a sigh of infinite relief
when the captain was buried with full military honors in
."Vrlington cemetery.
Somehow or other, Webster seemed to be the only one
who could bring a sense of decency to the captain when
he was drunk and abusive. One day, in the midst of a
lesson, we heard him in the hall, cursing and swearing,
and the soft voice of Mrs. C. trying to quiet him and to
keep the sound of the disturbance from the neighbor's
ears and mine.
Webster stood up. "Please may I be excused. Miss R?"
he said, and went into the hall, closing the door tightly
after him. This is what we heard through the closed
door, and I could almost see the boy, standing at attention,
as he always did when he addressed his father or any
superior officer.
"Captain C!"
"Yes, sergeant."
"That is my m-m-mother you are t-t-talking to."
"Yes, sergeant."
I could hear the click of the captain's spurs as he
turned on his heel and walked away. A blessed silence
fell and Webster came back into the room again, closing
the door softly behind him. He took his place at his
desk and the lesson went on.
There had been two older sons, and there was an aston-
ishing difference between their ages and those of the
two younger boys whom I was teaching at the time.
The ''Ider, a young lieutenant at a southern post, had
inherited his father's taste for liquor and just before I
had known them had committed suicide there for the love
of a beautiful young divorcee who didn't give the snap
of her finger for him.
294
THE MODERN HOSPITAL
The younger, a lieutenant, too, fell at San Juan Hill, a
brave soldier and a gentleman to the last, sacrificing him-
self for the safety of his company, they said. The captain,
the boy's father, redeemed him.self there too, and died
soon after the Spanish-American war, worn out by grief
and drink.
But to come back to my story and Webster again. The
old regimental bugler had taught him to play the calls
and the battery had presented him with a bugle when he
had learned the.m. It had a long red cord and tassel on it.
Every morning, as I rounded the driveway to the officers'
loop, a soldierly little figure would appear in the door-
way of the captain's quarters blowing the school call, and
the day that I left the reservation the same sturdy figure
stood in the doorway and blew taps for me.
Fort was on a high bluflF over the lake. Be-
tween the officers' loops were deep wooded ravines. One
of these had a road in it, making an even incline down to
the lake shore, and in the winter, an ideal place for bob-
sledding.
Webster had a girl, even at this early stage. I remem-
ber she had very blue eyes and a lot of gold curls, and was
a little younger than he was; about half past seven, I
think. You couldn't imagine a prettier sight than Webster
and Blossom sledding down that ravine in their red caps
with the snow and the big pines for a background.
One day, during the Christmas holidays, to avoid run-
ning into some other children on a sled ahead of him,
Webster crashed straight into a big tree stump. He got
up, told Blossom to take the sled home, and walked about
three blocks to his quarters, went upstairs, undressed him-
self and went to bed. He waited til! he heard his mother
pass the door of his room and called her in. "Mother,"
he said, "I think I am hurt, will you please call the major
surgeon?"
After the major surgeon had examined him, he said,
"Good Heavens, child, did you walk all the way home?"
"Yes, sir."
"And you didn't cry when you were hurt?"
"No, sir; you see, Blossom was on the sled, and I
c-c-couldn't cry before a g-g-girl."
The major surgeon carried the boy very tenderly to the
post hospital, and they tried to repair the damage. By
this time the news had spread through the post that
Webster had been badly hurt, and excited groups of
soldiers were standing about the barracks and the drill
ground demanding news of their small comrade, whom
they all adored.
At the hospital, when they put the boy on the operating
table, the major surgeon said to him, "I'm going to have
the doctor here give you something to put you to sleep,
so that you won't feel anything."
"Oh," said Webster, "that's the stuff that makes you
so s-s-sick to your s-s-stomach. If you please, sir, I would
rather stay awake if you don't mind."
"But you never in the world can stand what I have to
do to you without an anesthetic, and you couldn't keep
still enough."
"Oh, yes I can, sir, if you will just go s-s-slow and do
the best you can not to hurt; I won't move a b-b-bit or
cry or do anything to bother you; you just t-t-try me,
sir, please."
So he lay quite still and never even cried when the
major surgeon dug out, from less than a half inch dis-
tance from his spine, and from a depth of two inches, a
collection of cloth and underwear and a big piece of wood
from the bobsled, and the splinters that had broken off
and driven themselves into the flesh.
For a week after that we had a mighty sick boy on
our hands — so drowsy and feverish most of the time. The
doctors were worried and the regimental chaplain, a priest
at this time, had special prayers said in church for him,
and many a rosary was said by soldiers who usually went
to church only when they had to.
At any rate, either because of the prayers or because
we could not spare him, Webster got well, and stood
straight and strong again, and if he is alive today I know
that he must be in this war somewhere. And I'll bet he
doesn't drive his men as the German officers do, but he
will be the first over the top, with his head held high,
calling his men to follow, even if he stutters while he
does it.
INEXPENSIVE AND SERVICEABLE WARDROBES
How Burke Foundation Has Solved the Difficulty of High-
Priced Building Material
The Burke Foundation
MARY R. RUHL. Supervisor of Occupation,
for Convalescents, White Plains
N. Y.
Wood wardrobes are always discouragingly expensive
for "what you get out of them." Metal lockers, if in size
to be effective for wardrobe use, are well-nigh prohibitive
in price. Yet there are many places in hospitals where
built-in closets are not available or feasible, for various
fompo-lif.artl wardrobe, open and closed.
well-known reasons. Especially is this true in adaptation
of quarters, as experience has proved. Closets often
come in the way of right bed-placing and capacity.
To overcome this difficulty, we make small wardrobes
of compo-board in the patients' workshop which are very
satisfactory. The frames are of cypress or pine 1%
inches square and grooved % inch deep to take the compo
sides and back. The usual measurements are: height
over all, 6 feet 5 inches; legs for cleaning, 4 inches;
cross-section, 18 or 24 inches square; cypress shelf, %
inches and 11 inches from top to give large hat- room;
hooks under shelf and on corner posts — also on outside
frame if needed (towel rods have also been screwed on
outside).
The wood is usually painted dark buff and the compo
lighter. The wardrobes look well. One serves two or
three convalescent patients adequately, and the larger size
is used in employees' rooms. Many will be made and
used here.
The cost, including handicapped labor at 20 cents per
hour, is about $6 each. Some saving could be made by
nailing the compo on the frame instead of grooving in,
but the result would be inferior. Size, shape and detail
may be variously modified to fit individual need.
THE MODERN HOSPITAL
295
INDUSTRIAL
REHABILITATION
OF DISABLED
SOLDIERS AND SAILORS
Conducted by ELIZABETH G. UPHAM.
Director Art Department Milivaukee-Downer College.
BLINDNESS A TEMPORARY DISABLEMENT
Soldiers Who Have Lost Their Sight Quickly Fitted to
Assume Remunerative Positions in Civil Life — Ideal
Atmosphere Characterizes Rehabilitation at
St. Dunstan's — Cheer the Keynote
By MRS. SIDNEY McCALLIN. a Worker with 1h? Staff of St.
Dunstan's Hostel in London, England.
Nineteen fourteen is associated in the epochs of his-
tory with the most intense suffering and the greatest
reconstructive progress the world has ever witnessed. A
man gives his sight for the humanity of the world, and
reconstructive work has proved that the world has hap-
piness to give him in return. Forget the figure of sad-
ness, the blind and lonely musician, fiddle and alms-cup
in hand, for whom the world, in its ignorance of life's
possibilities, has known but pity. It was the thought
of this figure which inspired a great man — a man pecu-
liarly suited to the task — to establish St. Dunstan's, the
magnificent institution which was to render such a plight
impossible for Great Britain's soldiers and sailors.
Sir C. Arthur Pearson, Bart., himself a blind man who
had lost his sight directly previous to the declaration of
war, perceived in the reclamation of the blind the pos-
sibility of a great field, and America, through the gen-
erosity of Mr. Otto Kahn, of New York, had the privilege
of extending a helping hand in the enterprise by supply-
ing necessary quarters for this home.
The institution was founded to meet the need of re-
habilitating about forty men. The hostel now accom-
Fi-j. 2. The da
typewritin--: at St. Dunstan's Hostel.
Fig. 1. Sir Arthur Pearson.
the outbreak of the present
Hostel for the rehabilitatior
he publisher, who lost his sight before
war, and who has founded St. Dunstan's
of blinded sailors and soldiers.
modates, in the original house and its various annexes,
over five hundred. Up to the present time between three
and four thousand men have been graduated from its
various departments, fully equipped to take up life anew.
Let us, in imagination, follow the progress of one of
these interesting characters through the period of time —
from twelve to fourteen months, as the case may be — in
which he takes the first great step in his new life in the
blind world.
Nestled in the fresh greenery of Regent's Park and
guarded by the grim, grey spires of London, is St. Dun-
stan's. It is here that our blind man goes to begin life
over. Not an entirely strange world it is to which he
comes as he enters his new home, for, from the time
he has found himself in bandages, lying in a military hos-
pital, he has been visited by representatives of the staff
of St. Dunstan's, and he himself has made occasional
visits to the hospital during his convalescence. Amid the
welcome of the staff sisters, who are members of the
Voluntary .-Md Detachment of the British Red Cross, he
finds it a pleasure to learn that he is to be completely
outfitted with necessary clothing and given a Braille
watch with which he can tell the time by touch, and that
he is to be able, in a personal interview with the chief
himself, to choose his future vocation. In his new en-
vironment he might question his ability to be independent,
but he is pleasantly surprised to find that it is with
comparative ease he makes the first tour of inspection.
He learns that, if he be a Scottie, other kilties will sit
with him at the table; or that if, by chance, he has come
from the Land of the Maple Leaf, brothers from over
the water will be beside him. Suddenly he perceives that
he is walking upon a pathway of linoleum flanked by
strips of carpet. By this time he has realized that there
are turnings in the pathway which lead him to boot-room.
296
THE MODERN HOSPITAL
barber-shop, work-room, and other apartments of the
building, among which is the inner lounge, where he is
greeted by varied sounds. His ear distinguishes between
the ticking of several typewTiters and the buzz of con-
versation, indicating the fact that the boys are entertain-
ing their friends. He is told that a four at Braille domi-
noes ai-e having an exciting game, and that the piano in
a far corner is being played by a blind pianist to while
away the time for those who might feel dull. Besides
being taught Braille, so necessary to the blind, every St.
Copyright by Western Newspaper Union Photo Service.
Fiff. 3. Corner of carpenters' and ji>iners' shop at St. Dunstan's.
Dunstan man learns the use of an ordinary typewriter,
with which he is provided upon leaving the hostel.
Our blind man has his choice of the following voca-
tions: a full training in massage, including pathology,
which equips him to be of service at the present time in
military hospitals and later on in private practice; poultry
farming, which takes him into the art of the rearing and
disposition of stock; and cai-pentry, with a department for
picture-framing, which includes the fabrication of simple
furniture and trays. This last department is taught by
a blind man. Cobbling, which is of use to men living
in small towns, is also taught, and basket-weaving is
being done the world over by the soldier-blind with as
much efficiency as by the civilian who has lost his sight.
Liberty & Co., with its high-class reputation, sells the fiber
mats made at St. Dunstan's, and Gamage & Co., of Lon-
don, sells St. Dunstan's twine hammocks. This fact in
itself speaks for the efficiency of these departments.
Braille shorthand and telephone operating are being
taught to some e.\tent. It is of interest to realize that,
in his establishment of the trades taught here, Sir Arthur
Pearson has not in any way encroached upon the fields
already occupied by the civilian blind.
But "all work and no play makes Tommy a dull boy,"
and please don't think of our blind man as dull, for in
reality he whistles and sings throughout the day. Nine
o'clock finds our men assembled to hear the important
news of the day read from the daily paper. From nine-
thirty to twelve and two-thirty to four-thirty they are
in the work-shops, with a happy intermission at noon,
during which time there is a bit of dancing if the Cold
Stream Guards Band is at hand, and if not, a walk
around Regent's Park with an interesting companion, or
perhaps a trip to town to do a bit of shopping. On the
evenings when nothing exciting is planned it is not an un-
usual sight to see many couples making off to near-by
tea-shops or going out in groups for an hour's motoring.
Often a theatrical company from the West End of London
comes out to entertain what they consider the most ap-
preciative audience in London ; or occasionally an hour
of choice music is enjoyed by the "boys."
After supper our happy family gathers around its
own fireside and its members enjoy the privilege of
entertaining each other. Many a fiery debate based on
current events takes place, and occasionally Sir Arthur
Pearson himself is a delighted listener. A rare Welsh
voice is often heard, and on very special occasions St.
Dunstan's rag-time band is induced to play. The mem-
bers of the band, with the exception of the pianist, are
all blind. During these concerts one frequently hears a
faint click here and there among the audience. Every
smoker is in possession of a tiny tin box into which, out of
Fig. 4.
Copyright by Western Newspaper UnJMt
Blind men at St. Dunstan's learning to ni;
Liberty & Co. sells the fiber mats made he
consideration for the sister responsible for the spotlessness
of the assembly room, he drops his match-ends and ashes.
In the winter months directly previous to the Christmas
holidays, the Christmas pantomime is usually rehearsed
under the capable direction of St. Dunstan's quartermas-
ter, an artist in his profession.
It is not fair to leave our versatile character without
mentioning the sports which play such an important part
Fig. .^. Shoe-making shop at St. Dunstan's
THE MODERN HOSPITAL
297
in his life. With the coming of spring, the gymnastic
drill which is of such help during the winter months is
abandoned, for, throughout England, this season ushers
in one of the most favorite sports — rowing. And so we
find him practicing on the Regent's Park lagoon, in prep-
aration for the contest for possession of the silver cup.
Lest it be thought that the care of the men ceases with
their graduation from the hostel of St. Dunstan's, it is
interesting to know that an after-care department has
been organized, whose members keep track of the men
Fig. 6. St. Dunstan's rag-time band, with some of the sisters. All
the members of the band with the exception of the pianist are blind.
Note the happy expression on the faces of all the men in this and
the preceding pictures.
wherever they may be and see to it that their shops are
properly situated, that their homes are satisfactory, and
that their materials reach them in good order.
It is at home that the blind man most appreciates the
remarkably fine teaching he has received in the Braille
department at St. Dunstan's under a commandant of e.x-
ceptional understanding and her staff of capable teachers
and the system which keeps him in touch with the un-
usually fine Fully Contracted Revised English Braille
Library in London.
And now you will perhaps say, "What can I do to help
this great cause in America?" You may not know that
there is in the United States a fully organized institution
similar to St. Dunstan's. Li addition, there is an organ-
ization entitled the A. B. F. B. (American, British, French,
Belgian) Relief for Blinded Soldiei's and Sailors, which
■ has pledged vast sums to France, which is now helping
St. Dunstan's, and which stands ready to act as a medium
for the the aid of our American men. And as America
so willingly stretched out her hand to help the blinded
soldiers and sailors of Great Britain, let her now prepare
to do as much and more for her own.
WHAT ONE STATE IS DOING
How Pennsylvania Is Planning to Help Its Soldiers, Sail-
ors, and Marines Crippled in War Service
In the Bureau of Employment of the Pennsylvania De-
partment of Labor and Industry, at Harrisburg, extensive
card files, recently installed, indicate where 42,111 soldiers,
sailors, and marines, crippled or permanently disabled
through war service, may find in Pennsylvania suitable
employment despite their various disabilities. More than
one-half of the 42,111 employment openings, in virtually
all sections of the commonwealth, are in skilled tasks that
may be performed by men having lost one or both legs, an
arm, or who are handicapped by other disability. Places
of employment range from steel mills to dairies, from silk
mills to railroads, from cigar factories to paper mills, and
from lumber camps to department stores. The great num-
ber of eninloyment opportunities for crippled war veterans
are classified in the bureau of employment by industry,
by locality, by occupation, and by disability of workers to
be employed. This classification has bsen made possible
by the patriotic responses of Pennsylvania employers to
a questionnaire sent state-wide from the Pennsylvania
Department of Labor and Industry early this year.
On March 1, the total number of employment openings
so classified was 30,710. This number has increased to
42,111 to May 1, and is constantly growing, as replies are
still being received. Every Pennsylvania employer who
can give employment to war cripples handicapped by va-
rious disabilities is urged to notify at once the depart-
ment of labor and industry, Harrisburg.
The report of the progress of this work in Pennsylvania,
the first state in the Union to cooperate actively with the
national authorities in the effort to prevent war cripples
from being shunted merely into by-product industrial
tasks, was submitted to Acting Commissioner Lew R.
Palmer, of the department of labor and industry, by Jacob
Lightner, director of the bureau of employment. The
chairman of the Pennsylvania State Committee on Recon-
struction, Reeducation and Reemployment of Crippled Sol-
diers, Sailors, and Marines, recently appointed by Gov-
ernor Brumbaugh, is Adjutant General Frank D. Beary;
the committe, which includes Acting Health Commissioner
B. Frank Rnyer, .\cting Commissioner of Labor and In-
dustry Lew R. Palmer, and Dr. J. George Becht, Secretary
of the State Board of Education, has general supervision
of the reconstruction program for the commonwealth.
The national authorities are planning to equip each dis-
abled soldier and sailor with every suitable appliance to
bring his physical efficiency to a maximum and to give
him suitable treatment and training to adapt him for the
tasks in industry he can most advantageously perform.
Prom the classified employment lists of the department
of labor and industry, each Pennsylvania soldier, sailor,
and marine disabled in war service will be able to obtain,
from thousands of openings in his home state, a task for
which he is best suited physically, a task that will give
him greatest financial return according to his capability
and probably in the city or town where he most desires
to reside.
The questionnaire sent to employers by the department
of labor and industry designated thirty-eight general
classes of disability which might result from w-ar wounds
to handicap the soldier or sailor when he desires to engage
in industrial work. These disabilities include loss of one
or both of the upper extremities in whole or in part, stiff-
ness of the upper extremities in whole or in part, loss of
one or both of the lower extremities in whole or in part,
blindness of one or both eyes, deafness of one or both
ears, loss of speech, repulsive facial disfigurements, hernia
and genera! health impairment which would prevent heavy
manual labor.
The complete list of employment openings in Pennsyl-
vania, tabulated in the bureau of employment from replies
received up to May 1, according to the various classes of
disability, are as follows:
Number of
Disabi.i-y openings
Loss of fingers One hand 4,451
Both hands 729
Loss of hand at wrist One hand 45S
Both hands 3
Loss of arm below elbow One al-m 374
298
THE MODERN HOSPITAL
328
2,321
Both arms
Loss of am, at shoulder g^fh Tms! i ! ! ! ! ! ! !
Stiff finger-joints Or^ h-^. ........•■•••■■ ; ^-^
. . ^ Cino. arm 604
stiff wnst-joint ■ \^^^ arms! V.\ 499
Stiff elbow-joint One arrn^ 8^7
Boin arms _^^
stiff shoulder-joint Both ams! ! ! ! 1 ! . . ! 1 ! ! 1 '• : : : 80
Partial loss of foot B^th f^t! ! ! ! ! ! l ! . ! : '. ! i i i : • tw
Loss of foot at ankle g"t'h f«t' ' ' ' l '■'■'■'■ '■ '■ '■'■'■'■ '• ''"oi
....One lee ?93
Both legs 1;^
Loss of leg below knee.
Loss of leg at middle of thigh One^ le?^
Loss of leg at hip-joint. . .
Both legs..
..One leg...
Both legs . .
Stiffness of lower extremities One leg...
Both legs . .
Blindness One eye...
Both eyes .
Deafness One
432
Hi!
4,021
Both
Loss of speech e'79<!
Repulsive facial disfigurements "-^g^
General hcal'thimpairmen't, preventing heavy manual labor 1,321
MisceUaneous • '■•^^'^
Total 42.1"
Second Annual Meeting of the National Society for the
Promotion of Occupational Therapy
The business meeting was held on the morning of Labor
Day. In the afternoon a visit was paid to the splendid
workshops at Bloomingdale Hospital, where Dr. Russell
sketched the history of the institution in a short address
of welcome, after which tea was served and the shops
visited. The scientific session was opened on Tuesday,
September 3, with a paper on "The Principles of Occupa-
tional Therapy," by Dr. W. P. Dunton, in which he urged
that the society formulate the fundamentals of the sub-
ject for the guidance of beginners in the work. A com-
mittee consisting of Dr. W. L. Russell, Mrs. Eleanor C.
Slagle, and Mr. Norman L. Burnette was appointed for
the purpose of making up a report, which will appear in
the October number of the Maryland Psychiatric Quar-
terly.
Miss Eveljm L. Collins spoke on "The Remuneration of
Teachers," and a committee was also appointed to bring
in recommendations on this subject. Some of those pres-
ent seemed to fear that this might be regarded as an at-
tempt to unionize although it had been clearly expressed
that the purpose of introducing the subject was that
teachers might be accorded a proper recognition and that
hospital superintendents might have some criteria for
action. In such a report, it is necessary to consider a
number of factors, such as hours of duty, maintenance,
training and experience, number of pupils, etc., all of
which it is hoped will be given proper value by the
committee.
Dean Russell of Teachers College, in a stimulating ad-
dress, requested that the society determine the minimum
requirements for a course of training for occupational
aides. The board of management is at present working
on this matter, and their recommendations will appear in
the October Quarterly.
During a pleasant visit to the Red Cross Institute for
Crippled and Disabled Men on Tuesday afternoon ad-
dresses were made by the assistant director, Mr. H. R.
Hayden, who outlined the work of the institute, by Miss
Randolph, who described the speakers' bureau, by Miss
Bulliss, who told of the industrial surveys which had been
made under her direction, and by Miss Stein, who spoke
of the placement of cripples by the employment bureau.
Much interest was shown in Mr. Kidner's address Tues-
day evening on The Work of the Canadian Invalided Sol-
diers Commission, which was illustrated with three reels
of pictures. Miss Susan C. Johnson gave an interest-
ing description of work at the Montefiore Home, illustrated
with lantern slides.
On Wednesday morning the subject of training courses
was discussed by Miss Susan C. Johnson, Mr. N. L. Bur-
nette, and Mrs. E. C. Slagle. In her paper Miss Johnson
spoke of the desirability of standardizing products in or-
der that there may be an improvement in the design and
utility of the products of patients' labor. Mrs. Mary J.
Sullivan, formerly connected with Pratt Institute, was
appointed chairman of a committee to take charge of this
matter.
A visit was then paid to the Clinic for Functional Re-
education of Disabled Soldiers, Sailors and Civilians, at
5 Livingston Place, where Dr. W. Oilman Thompson
escorted the members about the institution and explained
its workings.
The afternoon session was opened by a paper by Dr.
S. Wachsmann, of the Montefiore Home, on "The Re-
muneration of Patients." Although the speakers agreed
with many of the excellent ideas advanced by Dr.
Wachsmann, the paper provoked considerable discussion.
A committee was appointed, as suggested by Dr.
Wachsmann, to consider the subject and report to the
board of management.
The enthusiasm and satisfaction of those attending were
evidences that the meeting had been quite worth while,
and an excellent attendance testified to the interest which
is being taken in the subject.
The third annual meeting will be held in Chicago on
the second Monday in September, 1919.
Wherever we ai'e, however near the end of our running,
it is never too late to resolve that high thoughts and
brave qualities shall accompany us for the rest of our
journey. Such resolves may be easier for those who
have made them before and carried them out; they are,
undoubtedly, more difficult for those who have made them
before and then turned slothful and let them slide out of
grasp; but what is worth while to bear in mind is that
beginning again is never impossible; the field of effort is
open and who sets his will to work may achieve. — Har-
per's Weekly.
Today, whatever may annoy.
The word for me is Joy, just simple Joy:
The joy of life;
The joy of children and of wife;
The joy of bright blue skies;
The joy of rain; the glad surprise
Of twinkling stars that shine at night;
The joy of winged things upon their flight;
The joy of noon-day, and the tried
True joyousness of eventide;
The joy of labor, and of mirth;
The joy of air, and sea, and earth —
The countless joys that ever flow from Him
Whose vast beneficence doth dim
The lustrous light of day,
.'\nd lavish gifts divine upon our way.
Whate'er there be of Sorrow
I'll put off till Tomorrow,
And when Tomorrow comes, why then
'Twill be Today and Joy again!
—Atlantic Monthly.
THE MODERN HOSPITAL
299
This is a field of hospital activity which is in its initiaJ
stages of development only. Hospital executives by keep-
ing closely in touch with the great expansion in in-
dusti-ial medicine now taking place may find new and
perhiips unthought of possibilities of service opening
before them.
MORE SHIPS FROM HEALTHIER WORKERS
Conducted by BARROW B LYONS
Superintendent Delaware Hospitah Wilmington, Del.
Proposed Federal Control of Industrial Welfare
Industrial medicine and surgery on a more extensive
scale will be vigorously advocated by the Federal Govern-
ment provided the Senate Joint Resolution No. 63 is
passed by the House of Representatives. This bill is
framed to provide the personnel necessary to a national
campaign to promote such work.
The permanent benefits which will result from this
work, provided the proposed bill becomes a lavy, judging
from recorded experience, would be so evident both to
labor and employers of labor that a permanent expansion
in the field of industrial medicine and surgery would
result.
Today "big business" realizes the value of maintaining
the efficiency of the human machinery; but "big business"
exhibits greater intelligence than industry in genei-al.
Whether or not Senate Joint Resolution No. 63 is passed,
manufacturing concerns, large and small, will soon recog-
nize the necessity of carefully providing for the physical
well-being of employees to a far greater extent, especially
if health insurance laws are enacted in many state legis-
latures.
These great changes will have a profound effect upon
the organization of our hospitals, for they will tend to
take away moi-e and more "business" from the private
practitioner and bring it to institutions. How is the
physician and surgeon to be compensated? To what ex-
tent will existing' hospital facilities be used in this work?
How will the present hospitals be affected by the in-
evitable increase of company hospitals organized by in-
dustrial concerns to care for their own injured?
In order to answer these questions wisely, the hospital
executive must study the problems of industrial welfare
and keep pace with the great spirit of the times which is
transforming self-interest into service. Every hospital
has a service to sell to the industrial concerns in its
neighborhood. Ability to make this service attractive
and market it to good advantage will largely govern the
success of many hospitals in the future, especially those
located m or near industrial sections.
The hospital superintendent who possesses vision, cour-
age, and the practical common sense to transmute his
vision into fact will be able to seize this opportunity for
service and with it benefit all in his community.
Industrial medicine and surgery often has been found
to bn the key to problems between capital and labor.
It has served to increase the production and decrease
the cost of production in a number of mills and factories,
and at the same time to promote the health and happi-
ness and actually increase the wages of the workers. It
has served to promote loyalty of the workers and greatly
decrease the waste of a large labor turnover.
The Great Welfare Task Undertaken by the United States
Shipping Board Emergency Fleet Corporation
The most tremendous industrial welfare program ever
undertaken has been launched under the auspices of the
United States Government for the workers engaged in
building ships. Under the guidance of Lieut. Col.
Philip S. Doane, M. C, N. A., director of health and
sanitation for the United States Shipping Board Emer-
gency Fleet Corporation, standards of surgical and medi-
cal attention for the hundreds of thousands of men work-
ing on merchant vessels for the government are being
enforced.
Not only does Colonel Doane prescribe the standards
for first-aid and surgical treatment, but he must see
to it that the men in 171 shipyards, dotted along the
entire coast length of the Atlantic, Pacific, Gulf, and
Great Lakes of this country, live and work under sani-
tary and healthful conditions. He holds himself in large
measure responsible for good housing conditions, clean
restaurants, and pure water supply.
In every spot where ships are being built for the gov-
ernment he is seeking to cooperate with local authorities
in creating sanitary living conditions for the ship-
builders. With the help of the state of Pennsylvania, the
city of Philadelphia, and the Westinghouse Electric and
Manufacturing Corporation, he drained, mowed, and
sprayed with oil in order to exterminate mosquitoes,
fifteen square miles of marsh land surrounding the great
Hog Island shipyard in which 30,000 men are employed.
This was done because the many electric lights used by
the night shift attracted such hoards of insects that it
was impossible to get much work from the night men.
A NEW MANUAL OF WELFARE STANDARDS
One of the first steps Coloned Boane took in establish-
ing better conditions in many of the 168 shipyards was
the publication of printed standards covering the examina-
tion of viforkers, medical treatment, sanitation, restaui-ants
and lunch rooms, and housing conditions. This little
booklet, because of its application to so many shipyards,
is one of the most important set of health welfare
standai-ds ever established. It contains information which
would profit almost any industrial concern. In the intro-
duction to this book Colonel Doane says:
"A healthy and energetic force of woi-kmen is as
essential to the speedy construction of the ships as. a well-
laid-out yard, prompt delivery of materials, labor-saving
machinery or efficient methods of work.
"The building and operation of ships bv the U. S.
Shipping Board Emergency Fleet Corporation is the
greatest industrial task ever undertaken, and, being a
governmental activity, the hygienic and sanitary stand-
ards under which this work is carried on should be worthy
of adoption by private industry.
"The health of the workers also has a very direct in-
fluence upon the cost of building ships, for a dollar's
worth o' work should be obtained for every dollar paid
in wages. This is not possible with emp"loyees in ill
health or with lowei-ed vitality.
"To obtain such conditions it is necessary that the
principles of industrial sanitation as established by actual
300
THE MODERN HOSPITAL
practice shall be as clearly understood and strictly con-
formed to. This requires the expenditure of funds, but
experience has clearly demonstrated that the investment
pays dividends.
"The enormous increase in the shipbuilding industry to
meet war needs has caused a constant influx of workmen
into the shipyards who are unused to the rigor and ex-
posure of shipbuilding. This condition demands unusual
care to safeguard their vitality."
Every shipyard coming under the jurisdiction of the
Health and Sanitation Department must provide surgical
and medical attention according to the size of the plant.
In some of the very small yards in which only a few
hundred men are employed a first-aid kit suffices when a
Fig. 1. First Aid Station planned for small firms by Dept. of Health
and Sanitation, U. S. Shipping Board, Emergency Fleet Cor-
poration.
physician living in the neigh-
borhood of the plant is on call.
Figure 1 illustrates the re-
quirements called for by the
manual of standards for
plants employing from 1,000
to 2,500 men, and Figure 2
shows the plan suggested for
firms employing 5,000 men or
more. The department rec-
ommends that, in addition to
the facilities shown in the '""'>=•
cut for a first-aid station, space be provided especial-
ly for the physical examination of employees. It is
also recommended that, in the larger plant dispensary
shovni in Figure 2, a diet kitchen be provided when
patients are kept over night and not simply moved to a
larger hospital as soon as possible.
BRINGING 171 SHIPYARDS INTO LINE
The extent to which each yard cooperates with the De-
partment of Health and Sanitation of the United States
Shipping Board Emergency Fleet Corporation depends
entirely upon the size of the yard and the management of
the plant. In the yards which are operating under "lump
sum" contracts the Shipping Board has no direct financial
responsibility. It simply recommends what its physicians
and engineers think should be done, and, on the whole,
this is carried out very well. Considerable control is
exercised in most cases because the contracts state that
the Shipping Board shall have control of the conditions
under which ships shall be built.
In the "cost plus" yards it is a simpler matter. In
these yards the government pays all the bills; so there is
less hesitation upon the part of the managements in
complying with our recommendations. If there is any
hesitation the Health and Sanitation Department simply
tells the district officer or supervisor what it wants done
and the order is given that it is to be done. An instance
which illustrates this control occurred when the depart-
ment gave orders that all of the employees in the yard
of the Maryland Shipbuilding Company at Salus Point,
IVIaryland, who would voluntarily be inoculated with
typhoid vaccine should receive the injections.
There is another class of shipyard in which the depart-
ment controls the situation more closely. These yards
are primarily shipping board yards, such as the Hog
Island yard, which employs 30,000 men. In these yards
the Emergency Fleet Corporation establishes its own
dressing stations, hospitals and laboratories, and employs
the men who are to operate them. Its own corps of sani-
tary engineers looks after the health conditions and, in
some cases, its own housing experts plan and build
dwellings for the workers.
The Hog Island plant carries its own workingmen's
compensation insurance. In most of the contract and
"cost plus" yards the Shipping Board has persuaded the
insurance carriers selling liability insurance to provide
their own physicians. Insurance companies have found
that it puts many dollars into their own pockets to furnish
their own surgical service.
REACHING OUT INTO THE COMMUNITY
When it comes to supervising the health of the com-
munities in which the workmen live, a very difficult
problem has been faced. If health conditions in a town
are not satisfactory the Health and Sanitation Depart-
ment first of all tries to get the local authorities to co-
operate with them. It tries to get them to reorganize,
furnish the funds with which to do their own job, and
undertake their own housecleaning. If the department
does not find cooperation forthcoming it tries to get the
state authorities to assume control of the district. The
United States Public Health Service can be called into
cooperate with the state and city officials. In extra-
cantonment zones the Public Health Service can always
be relied upon to help out, and it may be that extra-
shipyard zones in which the Public Health Service can
be called upon to perform like services may have to be
established. A good example of what can be accomplished
when all forces work together occurred when city, state
and Federal authorities helped to clean up the town of
Alexandria, Va.
The control of venereal diseases is considered one of
the most important problems, for these scourges not only
cause many days of disability but tend to slow down the
work of many men who are able to be on the job. Four
methods of attacking the problem are being employed.
In the first place, at the time of examination, every
man is given a little pamphlet called "Your Job and Your
Future," printed originally for the army, which sets
forth the plain facts regarding venereal diseases in a
way which any workman who reads English can easily
understand. In yards directly controlled by the Shipping
Board, men who are apparently infected are given a spe-
cial clinical examination; and this is urged in all plants
indirectly controlled by the board. Special literature is
given to men found to be infected in order to prevent
them as far as possible from infecting other workers
through towels, dishes, etc.
In the second place, a series of lectures given through
the cooperation of the Council of National Defense has
been started. Comparatively few men, however, have
yet been reached in this way. Thirdly, the five-reel film,
"Pit to Fight," which has been prepared by Colonel W.
THE MODERN HOSPITAL
301
0. Owen of the Army Medical Museum for use in the
army, is being shown to the men in the yards. Finally,
cooperation with the Bureau of Venereal Diseases of
the United States Public Health Service is urged at
every opportunity. According to Colonel Doane, Colonel
Owen has helped tremendously in malting- the educational
work along these lines effective.
PHYSICAL EXAMINATIONS FOR ALL WORKERS
Physical examination of all new employees is required
in all yards, and the Depai'tment of Health and Sani-
tation urges that reexaminations be made every six
months, largely because of the danger of venereal infec-
tions and possible tumors. In about three-fourths of the
shipyards which directly or indirectly come under super-
vision of the department, first-aid stations, dispensaries,
or hospitals have been established. In the remaining one-
fourth, which for the most pai't are small plants building
not more than one to two ships, there are fir.st-aid outfits.
It is evident that a mighty task confronts the men who
ai'e directing this work and that, while much has been
done, much still remains. Managers and workmen alike
must, in many cases, be persuaded to coopei'ate more
than they have yet done. In other cases, a strong hand
must be ur^d to force unwilling cooperation. Cities and
towns must be cleansed, marshes must be drained, and
hundreds of thousands of men must be examined and
reexamined — all that more ships may be built.
The lesson may be applied by industries of all kinds,
whether they dii'ect their energies toward making tenting
or ladies' pocket handkerchiefs. Each man released by
a more efficient working force from making ladies' pocket
handkerchiefs may be employed in making tents and
blankets, or in the manufacture of munition. In addi-
tion, the benefit to the health of the working people is a
permanent gain to the country which will outlast the
war and continue into that tremendously important period
which will follow, when American industi'ies will be pitted
against those of Europe in the most intense commercial
competition that the world has ever seen.
MEDICAL E.VAMINATION CARD SUGGESTED FOR
GOVERNMENT LABOR RECRUITING AGENCIES
MEDICAL INSPECTION JUSTIFIED
Statistics Taken in Two Inspectorates Show Work of
District School Nurses Necessary
After one month's experience in medical inspection of
school children attending rural schools in Saskatchewan,
it has been demonsti-ated that the department of education
is justified in the appointment of the two nurses who are
novif carrying on thu work, and that additional nurses are
necessary to extend the work. The figures compiled in
two school inspectorates from the nurses' reports are
taken as a fair indication of conditions prevailing in the
other school districts of the province where no efi'ort has
yet been made outside of the cities and larger towns to
inspect the health of the pupils. Thirty-five schools were
visited and 742 pupils examined. Of this number, 241
were found without defects, 74 defective in vision, 21 de-
fective in hearing, 240 with enlarged or diseased tonsils,
110 with adenoids, and 2.56 with carious teeth.
It is planned to extend the work by the appointment of
twelve more district school nurses, and the estimates of
the department of education at the next session of the
legislature will provide for this expenditure. The idea
is that eventually all the 41 school inspectorates into
which the province is divided will have a school nurse.
"True patriotism is doing one's duty wherever that duty
lies. Because of the shortage of assistants of every kind,
sick and wounded are bound to suffer unless voluntary aid
is offered."
.Ml Industries Throughout the United States Urged to Fit
Their Employees to Jobs for Which They Are
I'hysically Best Suited
Samuel Gompers, chairman of the Committee of Labor,
has I'ecomniended to Secretary William B. Wilson of the
Department of Labor that medical examination of ap-
plicants be made one of the functions of the government
labor recruiting agencies.
This recommendation was the outcome of a conference
under the auspices of the national sub-committee on wel-
fare work of the Committee on Labor held in New York
City July 15. The following resolution was adopted on
that occasion. It embodies the consensus of opinion of
experts on this subject, representatives of labor, employ-
ers, industrial physicians and public health workers.
"It is the sense of this conference that the physical examination
of workers is primarily a measure of health conservation and also
essential to ma.ximum production — a war necessity.
*'That the purpose of a medical examination is not to eliminate
the worker from industrial service but to adopt him to the work
he is physically fitted for. Therefore be it
"Resolved, in view of the public announced policy of the Govern-
ment centralizing: the recruiting of labor in the United States
Employment Service, that this conference recommend that medical
examination of the workers be one of the functions of the Govern-
ment Labor Recruiting Agency.
"It further recommends the establishment of a central examina-
tion board, composed of representatives of the workers, employers
and the Government.
"That this board issue examination cards indicating the health of
the workers and classify according to physical fitness.
"Such a system of centralizing physical e.xamination of workers
does not prevent employers from maintaining their own system of
physical examination and follow-up methods for the purpose of con-
serving the health of their workers."
It is intended that this should not prevent the employer
from supplementing these examinations and pursuing cer-
tain follow-up or curative methods, after using the infor-
mation thus gained, in placing men where they may be
safely employed.
The Committee on Labor has had prepared and sub-
mitted with this general recommendation a proposed
standard card to be used in making physical examinations,
believing that the entire plan would prevent duplications
both with reference to examinations and classifying and
recording them. The opinion is also held that to have
official examinations made by the Government would re-
duce about 50 per cent of the grievances resulting from
such physical examinations when conducted by employers.
It is believed that by having an adequate number of
physicians in each agency these examinations can quick-
ly be made; in addition, communicable diseases will be
detected, subnormal employees placed in occupations fitted
to their peculiar conditions, spread of communicable sick-
ness will be prevented, and employment of those who are
below par made possible — all of which will greatly aug-
ment and help to maintain the health of our industrial
army.
In indicating the possibilities of this plan Samuel
Gompers said:
"There can be no question as to the wonderful effects
that such a movement as here proposed will bring about.
It is only a matter of education before employers through-
out the country will come under this rule that people
should generally be physically examined and that the
examination should be standardized — at least the mini-
mum.
"Vv^ell. we are thinking in such terms now as would
have been impossible if we had not gotten into the war.
I feel that we are going through a baptism of fire that
will make for quicker and better thinking and a better
302
conception of life. It seems that in this world's history
it has been clearly shown that no human achievement ot
a tangibly great character has ever been accomplished or
ever will" be accomplished except through a baptism ot
fire It is the satisfaction of such achievement—and 1
have taken occasion to say that the newer conception ot
man's interdependence upon man; the establishment ol
new relations between man and man, as well as the new
relations between nation and nation, and the question ot
the centuries, 'Am I my brother's keeper? is being an-
swered now, and answered in the affirmative. W e are our
brothers' keepers! You cannot help it; you cannot get
away from it; the sluggishness of thought and the heavy
handicap upon the feet of progress have been cut away
and we are thinking more clearly and keenly and acting
better in one comprehensive whole — first, to win this war,
to root out autocracy, tyranny and injustice of all sorts,
as far as it is humanly possible to wipe them out, and
at last to give the opportunity for the development of a
higher and better mankind."
The following is a copy of the proposed standard exam-
ination card :
MEDICAL EXAMINATION RECORD
THE MODERN HOSPITAL
Mouth
Lungs and Heart.
Nervous System
Extremities
Special Comment
OF
Nam3 Address.
Age.
Color
Previous
) Male
-■"^ ( Female
Weight Height..
\ Married
: Single
[Widowed
Occupations -
General
Api-eakance
Skin
Eyes
Eais
Nose
J Right.
General
Special Comment
I DeformitiEs
-! Malnutritioii
[ Glands
Diseases, Eruptions. Parasites.
Vision iR^t *:.•;.■:/ with Masses | f ^f "'
Trachoma or other diseases
( Right
Hearing | Left • ■ • • ■
Obstructed breathing (caused ^V-:--
f 1 Excessive number missing .
Teeth \ 2. Excessive number decayed.
[ 3. Pyorrhea
Ulcerations ■ • •.
Other diseased conditions
Abnormal physical signs
Diagnosis .•••,••.■
Abnormal physical signs
Diagnosis
Blood pressure
(See note.)
Local paralysis
Epilepsy
Disease of nervous system
Deformities
Varicose veins
Flat foot
Hernia
Hemorrhoids
Evidence of active venereal disease...
.Test with ordinary dollar Ingel-soU watch held
at a distanace ot 2 feet from the ear.
Under Disease note particularly chronic puru-
lent otitis media.
.Even when a relatively large number of teeth
remain, note whether enough are in oppo-
sition for purposes of mastication. The
presence of pyorrhea should be determined
by making pressure on the gums.
.Note particularly presence of mucous patches
of secondary syphilis.
.Record physical signs that indicate eWdence
of abnormal conditions. Whenever prac-
ticable in examining persons of over 49
years of age. record systolic and diastolic
blood pressure readings.
.In examining for epilepsy note particularly
presence of scars on tongue. Examine re-
flexes (ocular, knee jerks, and etc.) K
there appears to be suspicion of nervous or
mental disease.
.The presence of disabling deformities should
be particularly noted. Note especially vari-
cose ulcers.
, Under this head it is desired that the medical
examiner should summarize all the abnor-
mal conditions found by him and make .'i
plain and direct statement, indicating
whether any of these conditions or all of
them combined would tend to disqualify the
applicant from general physical labor or
from special forms of physical exertion.
C.ENE^iAL Appearance.
(Signature)
( Date of examination )
Laboratory Diagnosis Sputum —
Tubercle Bacilli (if necessary)
Blood examination (if necessary)
Nature of Treatment or Care Required
Condition on Re-examin.\tion
(Signature)
( Date of examination )
EXPLANATORY NoTES : Make bold circle around .ibnormal conditions.
Address Under this head inquire as to places of resi-
dence in preceding three months.
Previous Occupations. .Inquire particularly as to exposure to hazard-
ous occupations.
.Note eruptions on skins, especially if commu-
nicable. Note presence of glandular en-
largements of abnormal character.
Under Deformities should be included loss of
a limb or of part of a limb, or the result
of serious injuries or loss of eye and also
faulty postural or spinal defect.
. I'est vision with Snellen Test type, at a dis-
tance of 20 feet if practicable, or employ
.Snellen Reverse Type card placed beside
applicant ?nd reflected in mirror at a
distance of 10 feet. When sight is defective
and glasses are obtained to correct same,
tests should be made with glasses to ascer-
tain their adequacy.
Under Diseases note any opacities of cornea
or other causes of defective vision, as well
as infectious eye conditions.
A New Hospital for the Royal Navigation Company
The increasing number of employees of the Royal Navi-
gation Company in Java made it necessary for this cor-
poration to establish its own hospital. It is located on
high ground and was commenced in 1914 and completed
in 1916. The main building, destined for Europeans
only, is a two-story structure, 76 meters long (about 230
feet). The corridor system permits ample classification
and isolation. Each room has two beds, the rooms in the
wings have from two to four beds. There is room for
78 patients in all. Special features are the wide and high
windows of the first floor and the airy, covered gallery
of the second floor constructed within the building. Be-
hind the main building is the operating pavilion and the
pavilion for natives with 72 beds. This hospital makes a
splendid impression, and speaks well for the progressire
spirit of the Dutch people. A full description accom-
panied by a number of fine photoprints appears in Zieken-
kuid, Amsterdam, 1918, IX, No. 2.
Life is a series of surprises, and would not be worth
taking or keeping if it were not. God delights to isolate
us every day, and hide from us the past and the future.
We would look about us, but with grand politeness He
draws down before us an impenetrable screen of purest
sky. "You will not remember," He seems to say, "and
you will not expect." — Emerson.
Do today's duty, fight today's temptations, and do not
weaken and distract yourself by looking forward to
things which you cannot see, and could not understand if
you saw them. — Charles Kingsley.
God has so arranged the chronometry of our spirits that
there shall be thousands of silent moments between the
striking: hours. — Dr. Martineau.
The man who never makes mistakes never makes any-
thing. Many chips, broken instruments, cuts and bruises,
belong to the history of any beautiful statue. — Anon.
THE MODERN HOSPITAL
303
Conducted by ANNIE W. GOODRICH. Dean Army School o( Nursing
and CAROLYN E. CRAY. Principal City Hospital School o(
Nursing. BlackwelPs Island, New York.
Please address items of news and inquiries regarding Department of
Nursing to CAROLYN E. GRAY. Principal City Hospital School of
Nursing. Blackwells Island, New York.
THE STANDARD CURRICULUM FOR SCHOOLS OF
NURSING*
The Opportuneness of Its Publication During the Great
War — Its Value to All Interested in Supplying
Trained Nurses in Large Numbers for
Work Over-Seas and at Home
By MABELLE S. welsh. R.N.. Assistant Dean. City Hospital
School of Nursing. Blackwell's Island. New York.
The profession of modern nursing has surely been
tested as by fire in the year that has just passed. In
spite of many efforts to break down our hardly-won
standards, nursing is stronger than ever before. Grow-
ing originally out of the needs of war, it shows at the
present time the value of the trained nurse as an indis-
pensable adjunct of the military machine. It is agreed
that "the trained nurse is playing a bigger part in this
war than in any previous war," and also that "she is a
trained and scientific worker, one to whom the government
should give every possible authority and recognition." A
representative just returned from a tour of the battle
front, including the evacuation hospitals in Paris and
some of the field hospitals, spoke enthusiastically of the
devotion and faithfulness of the nurses in these hospitals.
He said:
"My inspection of the front showed me that our great
need in the hospitals is for more nurses and yet more
nurses. Every possible means of getting recruits and
training them should be used in this country. We can't
.get them over too quickly. And all legislation which helps
the nurse and helps to make more girls want to be army-
nurses should be passed."
"I saw no more impressive sight during my trip abroad,"
said another Congressman, "than that of two young
women nurses, quietly waiting in the station at Boulogne
for the midnight train from the front which would be
filled with wounded men. Tired and worn, as their faces
showed, and bespattered, these girls waited there, quietly
and patiently, to do their share in making the lot of the
soldiers from the front a less painful one."
One of our own nurses in a recent letter tells of four
thousand soldiers being received in a period of one week,
and speaks of two hundred and sixty operations being per-
formed daily after the recent fierce fighting. So much
for the usefulness of our nurses abroad whom we are
asked to enroll at the rate of "a thousand a week!"
Think what that means to us at home! Highly trained
*The Standard Curriculum for Schools of Nuring was prepared
fcy the Committee on Education of the National League of Nursing
Education and published by the Waverly Press, Baltimore. Md.
women, training school superintendents, instructors, pub-
lic health nurses, social service workers, withdrawn from
our home work in large numbers! How shall we go on?
It is obvious that we must train more and better nurses
to fill our own depleted ranks, and to keep up with the
ever-increasing military demands. It is difficult to provide
this better training with our lessened staff of teachers
and administrators, women who cannot be raised up over
night, for our peculiarly technical work.
The institutions for higher education have come to our
aid generously, the most conspicuous instance, of course,
being the "training camp" at Vassar which is sending to
our schools this fall four hundred young women, who have
had a sound scientific preparation for nursing work. Two
years from now we shall expect much from these young
women.
Teachers College has given special courses for those
who are qualified to teach in training schools and is plan-
ning further and closer cooperation with our schools this
fall.
The Army School has triumphantly solved the problem
of the nursing in our many cantonment hospitals, the
story of which will be told in a later issue of this publi-
cation.
We have certainly never before so needed a standard
which shall serve the training schools, struggling under
extraordinary difficulties, through the sacrifice of their
best to the military needs. It is fortunate that we have,
at this particular time, such a help as our "Standard Cur-
riculum," for the harassed young superintendent or in-
structor to turn to for inspiration and very practical help.
It represents the best that has been worked out in our
schools, and is designed to give our young women in train-
ing- a broad foundation for their future work at home or
over-seas. It is the work of a splendid committee, of
which our Miss Nutting is chairman, and which includes
a group, each member of which is a leader in the nurs-
ing profession.
It is a democratic piece of work, because each outline,
after being worked out by a member of the committee
especially qualified in her particular subject, was sent to
representative training school superintendents, teachers, su-
pervisors, and public health nurses throughout the country
for careful criticism and suggestions. These suggestions
were then compiled, the outlines rewi-itten, and referred
back to the different members before being finally ap-
proved. Where there was difference of opinion the ma-
jority opinion was accepted. It is the intention of the
committee to revise the curriculum from time to time,
and the assistance of all interested in the better training
of nurses is asked to make this work of the utmost value
in establishing and maintaining good standards of nurs-
ing education. It is hoped that the "Standard Curricu-
lum" will be successful in interpreting to the general
public a fair idea of what, under our present system, is
conceived to be an acceptable training for tne profession
of nursing.
1 he general scheme of the book includes after the intro-
duction:—
1. The Relation of Hospital and Training School Or-
ganization and Administration to the Curriculum. In
this division such vital topics are considered as, "The
General Purpose, Character and Standing of the Hospi-
tal; the Form and Functions of Training School Control;
the Tyie and Capacity of the Hospital; Its Financial
Resources; the Teaching Field (Range, Variety and Char-
acter of Services); Conditions of Life and Work for Stu-
dents (Ratio of Nurses to Patients, Hours of Duty;
Housing and Living Conditions, etc.); the Administrative
304
THE MODERN HOSPITAL
and Teaching StaflF; Standards of Entrance to Schools of
Nursing; Standards and Methods of Good Teaching;
Teaching Equipment; Records; University Affiliations;
References on Nursing Education and Teaching." This
section provides, as will be seen, much information which
will enable the hospital superintendent, and trustees, as
well as the training school committee, to see the needs
of the school as such, and will be of use to them in meas-
uring up the institution which the school serves, to see in
what measure the existing services and general condi-
tions should be improved to add to the strength of the
course in nursing offered by their school.
2. The Course of Study includes (a) the General
Scheme of Theoretical Instruction and (b) the General
Scheme of Practical Instruction. Each subject is out-
lined (in the theoretical branches) giving the time allowed
to the subject, the methods to be employed, and the ob-
jects of the course. Laboratory work is advised
wherever possible, since no amount of book knowledge can
be as valuable as facts which the student has seen dem-
onstrated with material she has herself handled.
The value of the clinic is stressed for the same reason,
and excursions are urged as a modification of the demon-
stration, where students visit places illustrating certain
conditions which they wish to study. A group of junior
pupils who last year had the privilege of spending two
days each in visiting with the Henry Street nurses, will
never forget the impressions received, either of the worth-
whileness of the work of the visiting nurse, or the eco-
nomic and social causes of so much of the sickness seen
by them in the hospital wards.
The conference or case-study method is suggested for
the older nurse, especially in such subjects as "Profes-
sional Problems," "Introduction to Public Health Nurs-
ing," etc. The study period is advised for immature
pupils who need supervision, instruction in the method of
study, demonstrations in the use of reference material,
taking of notes, etc.
The outlines for the science courses are extremely help-
ful because they include suggestions for the laboratory
experiments in connection with the lecture and recitation.
Methods of teaching, equipment and illustrative material,
text and reference books are all discussed in detail.
Some of the newer subjects considered in the course
of study are: "Housekeeping Problems of Industrial
Families," "Public Sanitation," "Occupation Therapy,"
"Nursing in Mental and Nervous Diseases," "Nursing in
Occupational, Skin and Venereal Diseases," "Emergency
Nursing and First Aid," "Special Disease Problems."
Under "Social and Professional Subjects" are consid-
ered the "Historical, Ethical and Social Basis of Nurs-
ing," "Elements of Psychology,'' "Principals of Ethics,"
"Survey of the Nursing Field," "Professional Problems,"
■■'Modern Social Conditions."
"Special Branches of Nursing" include "An Introduc-
tion to Institutional Work," "Introduction to Piivate
Nursing," "Introduction to Public Health Nursing and
Social Service," "Laboratory Technic."
Public health nurses and social workers can no longer
say that the training schools do not recognize the value
of their work. Preventive measures are stressed through-
out the curriculum, as are the underlying causes of dis-
ease, economic and social. Not alone in the subjects
which deal most closely with these problems, but in every
subject, the value of education and the need for social
reform is emphasized.
The scheme of practical work is designed to give an
all-round knowledge of nursing procedures, and elective
periods are provided so that the pupil may develop her
special aptitudes, in a way not possible in the limited
period of the regular course.
No school is so small or so handicapped that it cannot
NURSING COMMITTEE OF THE GENERAL MEDICAL BOARD OF THE COUNCIL OF NATIONAL DEFENSE, (AT RECENT CONFERENCE
WITH COL. J. M. T. FINNEY IN WASHINGTON).
Lower row, left to rieht— Miss S. Lillian Clayton. Philadelphia, president National League for Nursing Education; Miss Annie W. Goodrich.
inspector general of Nursing Service in United States and France and dean of the Army School of Nursing ; Miss Mary Beard, Boston,
president National Organization for Public Health Nursing : Miss M. Adelaide Nutting, chairman of committee, professor of nursing and
health. Teachers' College. Columbia University, New York City: Mi-s. John H. Higbee, superintendent Nurse Corps, United States Navy;
Miss Dora L. Thompson, superintendent Nurse Corps, United States Army.
Second row, left to right — Miss Jane A. Delano, director Division of Nursing, Al
Nurses' Association ; Miss Ella Phillips Crandall, secretary of committee, ex
Nursing: Miss Hannah J. Patterson, resident director woman's committee. Council <
ant secretary of committee.
Third row, left to right— Col. John M. T. Finney, chief consultant in surgei-y. American E.\peditionary Forces in France; Col. William H.
Welch, Surgeon General's Office; CoL Wilham J. Mayo, chairman Surgical Advisory Board, Surgeon General's Office; Brig. -Gen. Robert E.
Noble, chief of Hospital Division, Surgeon General's Office; Lieut.-Col. Robert L. Dickinson, medical adviser. Operations Division, General
Staff: Dr. Franklin Martin, member of advisory commission. Council of National Defense, and chairman of council's General Medical
Board.
Red Cross ; Miss Clara D. Noyes, president American
secretary National Oi'ganization for Public Health
of National Defense ; Miss Pearl H. Braithwaite, assist-
E,xpeditionary Force
THE MODERN HOSPITAL
305
tenefit by enriching its curriculum. One small hospital
giving excellent surgical and obstetrical work to its
nurses, has greatly improved its course by an affiliation
with a contagious hospital, which teaches the most up-to-
date aseptic nursing of patients sufifering from communi-
cable diseases. This school also sends its nurses out for
a month each with the visiting nurse in the community.
The nurses go out in the morning only, and make their
first visit to each patient with the supervising nurse, yet
in one month they average one hundred visits. A course
in massage, given by a teacher from a nearby town, a
class I'oom, which had formerly been a dormitory for fe-
-male help, a small demonstration room; these facilities,
with additional graduate nurses, one to assist the many-
dutied superintendent of nurses, one to train pupils in
operating room technic, another to assume the responsi-
bility of the hospital at night, all were found to be quite
possible, even in a little institution much handicapped by
lack of funds.
Another larger and more prosperous hospital had no
space for laboratories for its nurses. An excellent tech-
nical high school in the community gave most coi-dial co-
operation, arranged special classes in chemistry, biology
and dietetics, at hours best suited to the needs of the hos-
pital, and gave splendid instruction to probation and
junior nurses, who attended the classes accompanied by
an instructor, who coordinated this work with the instruc-
tion given in the hospital. Not the least valuable of the
work given by the high school was a gymnasium course.
This was compulsory to all probationers and permissible
to others in the school.
Every community may be tapped for the training
school with benefit to both sides. In the rural distinct,
much might be done to interest the student nurse in the
needs of the rural community. A course in school nurs-
ing could be given and valuable clinics held with school
■children, by cooperating with the school committee.
The visiting teacher should play an important part in
the smaller school and the visiting teacher already finds
the "Standard Curriculum" of value when she is trying
to persuade the members of sceptical boards, of the value
of inti'oducing newer methods and equipment and of cor-
relating their work with all like institutions in the vicin-
ity, to enable them to train nurses properly for commu-
nity service.
The nurse is a public servant with distinct responsibili-
ties and opportunities. These ai'e considered throughout
the courses as outlined in the Curriculum, as is also con-
sidered the fact that the hospital must make an educa-
tional return to the students for the valuable pi'actical
nursing which is, after all, that upon which the hospital
is so dependent for the adequate care of its patients.
Students of the Vassar Training Camp Assigned to Duty
The intensive preparatory course given at the Training
Camp at Vassar was completed September 13, and the
students who have had the advantage of this special
preparation will continue their course in training in the
A'arious hospitals listed below: —
Albany General 3
Barnes Memorial, St. Louis 14
Bellevue 5a
Boston City 20
Brooklyn 18
Children's, Boston ■*
City, New York 26
Cincinnati General 20
Connecticut Training School, New Haven........ 10
Garfield Memorial, Washington ; 1
Hartford 8
Hahnemann, New York 4
Johns Hopkins 3
John Sealy, Galveston 2
Lakeside 29
Lane, San Francisco 2
Massachusetts Homeopathic, Boston 3
Massachusetts General 7
Memorial. Richmond 6
Mountainside. Montclair '. 1
Methodist Episcopal. Brooklyn 7
Military ig
Mount Sinai. New York 37
Pasadena , , . \
Pennsylvania. Philadelphia 10
Philadelphia General 21
Presbyterian. New York 24
Presbyterian. Philadelphia g
Post-Graduate g
Rochester General g
Roper, Charleston 1
St. Luke's, New York 5
St. Luke's, Chicago 2
Univei"sity of Iowa 2
Univei-sity of Michigan 13
University of Minnesota 1
Newton n
Toledo o
ENROLLMENT OF RED CROSS NURSES
Official Statement From Red Cross Headquarters— Pacific
Coast Leads in Percentage — Atlantic Division
Leads in .\ctual Numbers
In actual number of nurses enrolled with the Red Cross
since the United States entered war, the states of New
York, New Jersey and Delaware led on August 1, accord-
ing to a statement just issued from American Red Cross
headquarters. These three states, the Atlantic Division of
the Red Cross, have assigned to war duty 2,600 nurses, or
4.5 percent of their allotment of 5,708. To supply their
full quota, these three states in the next four and a half
months must enroll 3,108 additional graduates of recog-
nized schools for nurses.
The total number of war nurses assigned by the Red
Cross to war service, from the time the United States
entered the war until August 1, was 13,347. The Red
Cross is conducting intensive nurse recruiting campaigns
throughout the United States to secure for Surgeon Gen-
eral Gorgas 8,000 additional nurses by October 1 and the
remainder of the required 27,000 before the New Year.
Second in number of nurses supplied is the Central
Division — Illinois, Michigan, Wisconsin, Iowa and Ne-
braska— from which 2,311 graduate nurses have enrolled.
This is 58 percent of the quota of this division, which must
secure 1,629 nurses before the end of the year, to meet
its full allotment.
The New England Division states are third in number,
with 1,360 nurses assigned, or 41 percent of their allot-
ment and 1,958 nurses still to be secured.
Pennsylvania and Delaware have secured 00 percent of
their allotment, or 1,302 nurses. The Lake Division
Ohio, Indiana and Kentucky — has secured 43 per cent of
its nurses — 1,205— and has yet 1,543 nurses to enroll.
In percentage of quota of nurses secured by August 1,
the Pacific Division — California, Nevada and Arizona,
leads with 899 nurses out of its quota of 1,036 nurses,
or 87 percent of its allotment.
The Mountain Division, Wyoming, Utah, Colorado and
New Mexico, is second, having supplied 83 percent of its
quota, or 221 of the 264 nurses allotted to it.
The Southern Division, composed of Tennessee, the
Carolinas, Georgia and Florida, on August 1 had supplied
382 out of 1,371 nurses called for by January 1, or 28
percent of its allotment.
306
THE MODERN HOSPITAL
DEPARTMENT
OF
DIETETICS
Conducted by LULU GRAVES.
Please address items of news and inquiries regarding Department of
Di^tetTcs ?o the editor of this department, in care of The Modern Hos-
pital, 5S E. Washington St.. Chicago.
American Dietetic Association
A most successful meeting, judged from the point of
view both of attendance and of enthusiasm, was held by
this association in conjunction with the section on dietetics
of the American Hospital Association, at the Royal Palace
Hotel, Atlantic City, September 26-28.
Since this was the first meeting of the Association, it
was particularly gratifying to find so much interest mani-
fested by the dietitians of the country.
The following officers were elected: President, Miss
Lulu Graves, 58 East Washington St., Chicago; first vice-
president, Miss Lenna Cooper, Battle Creek Sanitarium,
Battle Creek, Mich.; second vice-president, Miss Violet
Ryley, Military Hospital of Canada, Toronto, Canada;
secretary, Miss E. M. Geraghty, New Haven Hospital,
New Haven, Conn.; treasurer, Miss Emma Smedley, 1425
Brandywine St., Philadelphia.
A number of very opportune and valuable papers were
read. A full report of the meeting of the American Diet-
etic Association will appear in November number of The
Modern Hospital.
DIETARY STUDIES MADE IN THE MISSOURI STATE
HOSPITALS FOR THE INSANE*
The purpose of the investigation was to determine the
adequacy of the dietaries which were being served and to
find out if they were being planned as economically as
possible. The data necessary to carry this out should
enable one to determine: (1), the calorie requirement of
the patients; (2), the amount of food served; (3), the
extent to which the food selected was meeting the require-
ments of the patients; and (4), the cost of the food
served.
CALORIE REQUIREMENT OF THE PATIENTS
With these groups of people it was felt that the main
factors determining the calorie requirement of the patients
were (1) the weights of the patients, and (2) the amount
of work done.
AVERAGE WEIGHT OF PATIENTS
It was not practical to weigh every patient in the hos-
pital, as some of them were bedridden, but between 75
per cent and 95 per cent of the total number of the
patients were weighed in each hospital. The low per-
centage weighed occurred in only one hospital. The
patients in the first two hospitals in which the investi-
gations were made were weighed on physicians' scales,
while those in the other two hospitals were taken out
to the stock scales and weighed in groups of from twelve
to sixty individuals. Either method used in weighing
caused very little disturbance among the patients, although
a few refused to be weighed. Many of the patients were
anxious to be weighed, and several hobbled out to the
scales when they had refused to go out of doors for many
months before.
The weights of the individual patients varied greatly.
For example, in a women's ward one patient weighed 350
pounds, while her companion weighed only 70 pounds.
Table I shows the average results of the weighings made
in each hospital.
TABLE I.— AVERAGE WEIGHTS OF PATIENTS IN THE
HOSPITAL.
Institution. Men. Women.
Hospital No. 1 141.2 pounds 125.8 pounds
Hospital No. II 141.6 pounds 115. pounds
Hospital No. Ill 143.3 pounds 131.8 pounds
Hospital No. IV 131. pounds 112. pounds
Investigation in Four Hospitals Shows the Necessity of
Practical and Well-Trained Dietitians
Bv JUNE FINDLEY, M.A.. Associate Professcr of Home Economics,
College o^ Industrial Arts, Denton. Texas.
The dietary inve.stigations were made in the four Mis-
souri State Hospitals for the insane, known as State Hos-
pitals No. I, No. II, No. Ill, and No. IV. The series of
investigations were started at the request of the superin-
tendent of one of the hospitals for some member of the
home economics department to visit his institution and to
advise him as to the suitability and the cost of the
dietaries which he was serving. With the cooperation of
the secretary of the State Board of Charities of Missouri,
Mr. Wagner, and the superintendents of the remaining
three hospitals, arrangements were made to extend the
visits to all of the state hospitals for the insane in the
state. The studies were made in March, April, and May
in the spring of 1917. The total number of persons con-
sidered in the study was 5,625; of that number 335 were
employees in two of the institutions.
The food department in Hospitals No. I, No. II, and No.
IV depended upon a matron to plan the dietaries and to
see to the preparation and serving of the food. Hospital
No. Ill was the only hospital at that time employing
a trained dietitian.
Degree, LTniversity of
Average in all Hospitals 139.2 pounds 121. pounds
It is of special interest to note that the patients whose
weights averaged the highest, both men and women, were
in the only hospital employing a dietitian. The average
weights would seem to indicate that the patients were
needing a liberal amount of food.
AMOUNT OF WORK DONE.
The second factor used in obtaining the energy re-
quirement of the patients, was the amount of work done.
This was determined as accurately as the time given to
the investigation allowed.
The patients were classed in two groups, the non-
working and the working patients. Those classed as non-
workers were the patients who were bedfast, semi-invalids
and those who were able to walk about but performed no
work at all, except a few, perhaps, who occasionally did
a small amount of light work.
The patients classed as working patients did not do a
uniform amount of work. A few of the patients worked
hard and used considerable energy, working on the hos-
pital farm, in the laundry, bakery, kitchen, and at various
other occupations. The majority of the working patients
assisted in serving the food, washed dishes, took care of
the rooms occupied by the patients and performed other
duties requiring a limited amount of energy. It was not
Feeding the Family, pp.
THE MODERN HOSPITAL
307
possible to classify the patients according to wards, as
they were classified according to the type of insanity with
which they were afflicted. For example, in one of the
epileptic wards in one of the hospitals two or three of the
patients were among the best workers in the hospital
when not having one of their disturbed periods, but the
majority of those patients were not able to do much,
if any, work.
CALCULATING THE ENERGY REQUIREMENT
In calculating the energy requirement it seemed that
by classifying as working patients the patients who
worked, even though they performed only a small amount
of work in a number of cases, there would be no danger
of calculating the energy requirement of the patients too
low. If there should be an error in the calculations, it
would be better to have the calorie requirement too high
than too low, because the average weights of the patients
were found to be below normal.
As far as can be found, the actual energy requirement
of the insane has not been worked out, so it was necessary
to figure the calorie requirement according to the amount
needed by normal adults who were doing what was thought
to be the same amount of work. The figures used were
based on those given by Mrs. Rose in "Feeding the
P'amily^." It seemed that for the patients classed as non-
workers 2,500 calories for the men and 2,000 calories for
the women per person per day would be ample in amount.
The men classed as working patients were calculated as
needing 3,000 calories per man per day and the women,
2,500 calories per woman per day. With these figures the
average calorie requirement of each patient in all of the
hospitals was 2,533 calories. This average requirement is
33 calories more than Dr. Atwater" considered necessary
to meet the physiological demands of such patients when
the number of men and women were half and half. In
the Missouri hospitals the men outnumbered the women
slightly.
THE AMOUNT OF FOOD SERVED
The next point considered was the calorie value of the
food served. In general, the calorie value of the food was
figured from the amount of the food materials the cook
and the baker used on two successive days. This was
felt to be a very fair average, since the data included the
food used on a meat and meatless day, and aside from
this difference the menus usually varied but very little. It
seemed that very little food value was lost in the methods
of preparation used, and it was impossible to weigh the
food after it was prepared, except in the smallest hospital.
TABLE 2.— AVERAGE CALORIE REQUIREMENT OF PATIENTS
AND CALORIE VALUE OF FOOD SERVED
Hospital Hospital Hospital Hospital
No. I No. II No. Ill No. IV
Average number of calories served
per person per day 3,227 3,074 3,175 2,868
Average number of calories required
per person per day 2.542 2.431 2,B46 2.614
Per cent of protein calories served. 12% 17% 10% 12%
According to the figures, the calories of food served
more than met the calorie requirements of the patients and
allowed a margin of from 15 to 20 per cent for waste.
In investigations made in similar hospitals in New York
and in the Government Hospital for the Insane in Wash-
ington, D. C, under the direction of Dr. Atwater,' the
waste of the food served to the patients was estimated to
be from 25 to 30 per cent, respectively. This amount of
waste, however, was considered unusually large and in-
cluded the plate waste and the food sent back to the
kitchen which had not been served.
Table 2 also shows the average percentage of protein
calories served. Hospital No. Ill served the lowest per-
centage of protein calories, but it was in the most avail-
able form. They depended largely upon milk, while
several of the other hospitals depended largely upon
legumes for protein.
SELECTION OF FOOD
The next point considered was the selection of the food.
A copy of the menus served for one week in each hospital
was obtained. In the average insane hospital it seems that
the menus are repeated week after week, varying slightly
with the season of the year. The following are sample
menus collected when the study was made.
SAMPLE MENUS SERVED IN ONE OF THE HOSPITALS
BREAKFAST
1st day 2nd day 3rd day 4th day 5th day 6th day
Fried liver Oatmeal
Bread Bread
Oleo Oleo
Sirup Sirup
Coffee Coffee
Milk* Milk
Beef stew Oatmeal Bacon Oatmeal
Bread Bread Gra\'y Bread
Oleo Oleo Bread Oleo
Sirup Sirup Sirup Sirup
Coffee Coffee Coffee Coffee
Milk Milk Milk Milk
=Rose: Feeding the Family, pp. 55, 76.
'Atwater: Dietaries for Hospitals for the Insane, State of New
York, State Coram, in Lunacy, Thirteenth Ann. Rep., p. IDS.
•Atwater, W. O. : Dietetics in Relation to Hospitals for the Insane,
Ann. Rep. of the Office of Experiment Stations for the year ended
June 30, 1904, p. 478.
DINNRR
Backbones Beef roast Pork and Pork Beef and Pig's feet
Wiener- beans dump-
wursts Gravy Parsnips Parsnips lings
Parsnips Potatoes Bread Bread Cornbread Navy beans
Bread Bread Dressing Tea Bread
7/S . Z^f, "^^"^ Tea Milk Tea
Milk* Milk Milk Milk Rice pud- Milk
ding
SUPPER
Hominy Mush Mush Rice Hominy Mush
Bread Bread Bread Bread Bread Bread
Oleo Oleo Oleo Oleo Oleo Oleo
nri"5 ?,"■•"? ^'™P S"™P Sirup Sirup
Dried Dried Prunes Prunes Dried Prunes
apples peaches peaches Milk
Cake Milk
•Milk was served to the majority of patients for only cereal and tea
or coffee.
S.\MPLE DINNER MENUS SERVED IN ONE HOSPITAL
1st day 2nd day 3rd day 4th day 5th day 6th day
^W„<, go^istbeef Na^-y Pinta Lima Roast beef
beans Beans beans beans beans Beans
Potatoes Macaroni Hominy Hominy Macaroni Hominy
Bread Bread Bread Bread Bread Bread
Oleo Oleo Oleo Oleo Oleo Oleo
Coffee Coffee Coffee Coffee Coffee Coffee
Sirup Sirup Sirup Sirup Sirup Sirup
The sample menus given were the skeleton menus used
for the hospital. Suitable changes were made for the
difl^erent classes, namely, those which partially met the
requirement of the working patients, tuberculous patients,
those in the receiving wards, and those patients on special
diets. The menus show that there was danger of de-
pending too largely upon cereals and legumes for calories.
The monotony of such diets is undesirable, but more im-
portant, of course, is the danger of using too much of
these foods in the diet. McCollum' has recently pointed
out the danger of using too many beans for food. Forbes*
says that a high ash is valuable and that the mineral sub-
stances should preferably yield a basic ash on burning in
the body. The amount of cereals used was large and the
amount of milk and other base forming foods was low in
a number of the diets.
Very little, and in several hospitals no, fresh fruit or
vegetables or leaf vegetables were being used. Since this
was true in several of the hospitals, it would seem that
those hospitals were failing to supply some of the im-
portant food constituents which are not measured by
calories. In Hospital No. Ill the dietitian was serving
a generous amount of milk and fresh and leaf vegetables.
Hospite! No. I was also serving a very good amount of
milk and some leaf vegetables.
'^McCoUum, Simonds and Pitz: The Dietary Deficiencies of the White
m. Jour. Biol. Chem., April, 1917, p. 626.
"Forbes : The Mineral Nutrients, in Practical Human Dietetics,
ir. Home Econom., March, 1916, p. 129.
808
THE MODERN HOSPITAL
The food in general in the hospitals was well prepared,
but a lack of variety was shown in the food materials used
and in the method of preparation in those hospitals not
emplojing a dietitian.
THE COST OF THE FOOD
In considering the cost of the food it was found that
the cost of the food materials used averaged 0.138 cents
to 0.257 cents per person per day. A number of factors
influenced the cost, but it seemed that the hospitals were
paying the minimum amount possible for their food, and
in several instances not enough to give the patients the
food they needed. The hospital paying the highest amount
was the one serving the most adequate food. The dietitian
had saved the superintendent of this hospital so much loss
from waste that he was able to spend this amount for food
and did not feel that the food used was costing more than
it had before the dietitian was secured.
CONCLUSION
The investigation showed there was need for great
hnprovement in the three hospitals and that important
food substances were being sacrificed, probably owing to
the high price of food, and it demonstrated the necessity
of having the food department controlled by a capable
and well-trained dietitian.
But the dietitian can not work alone; she must have
the cooperation of the one in charge of the institution,
and those contributing to its financial support, as well as
that of all employees working with the food department.
THE DIEITITIANS' QUESTION BOX
Gluten Flour for Diabetics
To the Editor of the Department of Dietetics:
Will you give me the name of a reliable brand of gluten
flour which would be safe for diabetic patients?
A Physician in Private Practice.
The gluten flours on the market are not safe for dia-
betic patients to use in unlimited quantities. The safest
way to use any flour or bread substitute for diabetics is
to choose either a gluten flour or bran with a known per-
centage of starch and use it in restricted amounts, accord-
ing to the condition of the patient. Many gluten flours
and brans are put in packages with the analysis printed
on the package or on an enclosed folder. Manufacturers
of gluten flours do not claim for them that they are free
from starch, but put emphasis upon the high percentage
of protein they contain. Since we know that sugar can
be formed from protein in the diet, we restrict the quan-
tity of this as well as of carbohydrate. Breads for dia-
betics are given as a means for serving butter, cheese,
peanut butter, etc., rather than for their high food value.
A very good muffin for diabetics may be made from equal
parts of bi-an and soy bean flour, the patient being given
one muffin daily, one each meal, or any number which the
physician decides is advisable.
The Food Value of Gelatin
To the Editor of the Department of Dietetics:
Has gelatin a high food value?
A Dietitian in a Small Hospital.
From the point of view of nutrition, gelatin is not of
great value. It cannot satisfy the protein requirement
of the body because it is lacking in amino acids and some
other forms of protein. While our tables on food compo-
sition rate gelatin as being about seven-eighth protein
that is, 34 grams of gelatin contain 31 grams of protein,
as we use it, this percentage is very much too high. An
ounce of gelatin will coagulate one quart of liquid; this
amount will make a dozen servings, making a very small
amount of gelatin in each serving.
The food value of gelatin is more than the nutritive
value, however, as it furnishes a good medium for serving
ci'eam, fruit juices, wine, and other things which are nour-
ishing or stimulating, and thereby giving variety to a re-
stricted diet. It may serve as a means of utilizing small
amounts of fruit, vegetables or meat which would not be
acceptable, or sufficient in quantity, if used alone. Gelatin
dishes can be made very attractive, and that is also a
feature which is valuable in a food.
A Nurses' Course in Dietetics
To Ihe Editor of the Department of Dietetics:
I should be very grateful if you would suggest an out-
line for a course of lessons in dietetics for nurses.
A Superintendent of a Training School.
This question is asked so frequently that one is made
to feel it a problem in a large number of hospitals. Con-
ditions differ so greatly that a course in dietetics which
may be applicable to different hospitals can scarcely be
outlined. A few general principles, however, may always
be followed. Soon after entei'ing school the nurse should
be taught how to care for milk and such other food ma-
terials as are kept in the supply cupboard of the ward;
how to prepare toast, eggs, and the various hot and cold
drinks — in fact, anything which is prepared in the ward
serving room — and how to serve a tray properly and ex-
peditiously. This can be done in three to five lessons.
In a later course the food value of all common food
materials should be given, including composition, diges-
tion and absorption, the efl'ect of cooking upon food value
and digestion, and the application of these principles to
dietetic treatment of disease. This may be given in twelve
lessons, but it would be much more desirable to have
eighteen or twenty.
As no textbook covering the various phases of the
subject is available, it is better to have more than one
author for reference; for instance, one giving a thorough
study of food materials, one on diet in disease, and one
on nutritional physiology. This aflfords an opportunity
for the nurse to get from reading information which she
could not obtain in the short period in the class room.
The more she learns of this subject, the more she realizes
its value. Our medical men frequently complain of the
lack of care given to the special diets; until nurses are
taught that the diet of these patients should be given the
same thought and attention as is given to the medica-
tion of medical patients there will still be cause for com-
plaint. Emphasis should be placed upon the practical
points, and their place in dietotherapy.
NEWS NOTES OF DIETITIANS
Miss Anne Upham, formerly assistant dietitian at Lake-
side Hospital, Cleveland, Ohio, is with Base Hospital No.
9, B. E. F., France. Her work has been so satisfactory
that she has been given a very decided promotion, and
her department is being pointed out as an example to
other base hospitals in the B. E. F. Recently Miss Up-
ham was asked to write an outline of her work and meth-
ods, that copies of it might be distributed in the other
hospitals. A part of this report is as follows:
"The work of the dietitian at No. 9 General Hospital
is not only concerned with the special diets but with the
THE MODERN HOSPITAL
309
diets of all patients in the hospital. There is no diet
kitchen for special diets only. Supplies ai-e very limited
and it seems best to work in close cooperation with the
main kitchen. For example: The heaviest part of the
special diet work comes at noon, when the dinner trays
are brought in. Bowls or small mess tins are placed on
the tray, so that it is taken to the wards with the ward
dinners, thus doing away with a special trip to the diet
kitchen. In the medical wards, the special diets consist
chiefly of diets for nephritis, gastritis, gastric ulcers,
chest wounds, and also for patients who, owing to a loss
of appetite, refuse to eat the ordinary diet. The special
diets for the surgical wards are liquids for operative or
other patients, for whom broth and milk soups and cus-
tards are provided; patients with jaw and face wounds,
for whom soft food, such as mashed potato, milk toast,
minced meat, etc., is provided; and extra nourishments
for patients whose resistance is low. These extra diets
include any nourishing food which can be obtained, such
as extra custard, bread pudding made from scraps of
bread, extra vegetables, soups, etc.
"The dietitian has control of the preparation and serv-
ing of the food for all the patients, both in the wards
and in the dining hall. There must be a close coopera-
tion between the quartermaster, the steward, and the
dietitian, as well as between the dietitian and mess ser-
geant. It is necessary that the dietitian know the ration
allowed by the British Government per patient, and then
make sure that she gets all that is due for the number
of patients in the hospital at that time. She also should
know what is brought in each day from the supply depot.
The food arrives at the hospital about noon. By after-
noon the dietitian should know what is in the store, pre-
pare the menus for the following day, and ari-ange the
work as to food, fii'es, boilers, etc., to the best advantage.
"The dietitian supervises the preparation of all foods,
making sure that the food is properly cooked and sea-
soned before leaving the kitchen. She also has charge of
the serving of food into the trays for the wards, seeing
to it that each ward has enough, but not too much, food
for the number of patients.
"Another important work carried out by the dietitian
is the work on the wards. She visits as many wards
as possible during meal times in order to control the
amounts of food used and to stop all waste. Regarding
special diets, the dietitian keeps in close contact with
the medical officers and sister (and patient if necessary).
"There is one more large problem which rests upon
the dietitian, and that is the serving of the patients in
the dining hall. The greatest difficulty there is to keep
the food hot and to see that each man gets enough food,
but not so much that some will be left on the plates or
tables. The bread is one item that has to be very closely
watched.
"In brief, the duties of the dietitian in this base hos-
pital are: (1) to supervise special diets (which includes
sick officers' diets); (2) to supervise the selecting (where-
ever there is any choice), preparing and serving of food
to the patients, in the kitchen, wards, and dining hall;
(3) to bring in closer union the serving of the meals in
the wards and the preparation of food in the patients'
kitchen. For example: Two wards may have the same
' number of patients; however, if they were given the
same amount of food. Ward A would have food left
over, while Ward B would not have enough to serve all
its patients. A more satisfactory division may be ob-
tained if one person remains in the kitchen when meals
are being apportioned and one visits the wards when
meals are being served to the patients.
2,500-BED UNITED STATES ARMY GENERAL HOS-
PITAL TO BE BUILT IN 100 DAYS
First Permanent Army Reconstruction Hospital to Be Built
at Chicago — Largest and Most Completely Equipped
in Country — Twenty-eight Buildings, Main Hos-
pital Building 2,0(0 Feet Long— Land. Build-
ings, and Equipment to Cost .S4,500.000
Considerable interest attaches to the Army General
Reconstruction Hospital to be built at Speedway Park,
Haywood, Illinois (a suburb of Chicago) in that it is the
first reconstruction hospital, of permanent construction,
to be built by the War Department since the declaration
of war. The land, main buildings, administration, receiv-
ing, kitchen, laundry, power, and seven storage houses
will cost $2,500,000,000, while the equipment will cost an
additional $1,000,000.
The plans were prepared by Richard E. Schmidt, Garden
and Martin, and construction has been started. The main
hospital building is to be completed within one hundred
working days, and it is expected that it will be available
for hospital purposes late in December.
The buildings already planned will occupy twenty-five
acres, although 312 acres were purchased to allow ample
room for such expansion as may ultimately be found nec-
essary. The hospital will be known as the United States
Army General Hospital and will be designated by a num-
ber. The plans call for one main hospital building and
twenty-seven auxiliary buildings, to be equipped with the
most modern appliances obtainable. The hospital proper
and the administration building will be of reinforced con-
crete fireproof construction; the hospital building to be
fifty feet wide by 2,040 feet long, and four stories. It
will have a capacity of 2,500 beds, it being planned to
care for 50 per cent of the patients in wards of one hun-
dred beds each and the remainder in smaller wards and
single-bed rooms. Each floor will contain eight sections,
with complete auxiliaries of kitchens, baths, quiet rooms,
utility rooms, laboratories and treatment rooms. A so-
larium and open-air balconies will be provided for each
section.
In addition to the main hospital building, an adminis-
tration building and power house will be constructed of
reinforced concrete, while the kitchen, laundry, machine
shop, laboratory, seven storage houses, chapel and I'eceiv-
ing station will be of mill construction with stucco ex-
terior.
One hundred doctors, 250 nurses, and 750 enlisted men
will be necessary to care for the patients. The nurses will
be housed in a group of five buildings, to be erected just
east of the main buildings; five more buildings will be
given over to the enlisted hospital corps detachment, and
the officers and doctors will be housed in two additional
buildings.
MEETING OF AMERICAN PUBLIC HEALTH ASSO-
CIATION
A convention of United States and Canadian sani-
tarians will be held, under the Auspices of the American
Public Health Association, at Chicago, October 14-17.
Among the prominent military sanitarians who will ad-
dress the meetings are Surgeon-General Gorgas, Col. Vic-
tor C. Vaughan, and Maj. William H. Welch, of the Army
Medical Corps. The speakers at the general sessions will
include George H. Vincent, president of the Rockefeller
Foundation, Dr. Charles J. Hastings, president of the
American Public Health Association, Dr. W. A. Evans,
Assistant Surgeon General Allan J. McLaughlin, U. S. P.
H. S., Dr. Ernest S. Bishop, Dr. Lee K. Frankel, and Dr.
Frederick L. Hoffman.
310
THE MODERN HOSPITAL
Group of delegates, members, and guests attending the Twentieth Annual Co
AMERICAN HOSPITAL ASSOCIATION MEETING, ATLANTIC CITY
Twentieth Annual Convention Deals With Vital Issues and War Program of Hospitals-
Patriotism the Keynote— Report of Work Accomplished and Some
of the Papers Read — Names of Those Present
The twentieth annual convention of the American Hos-
pital Association closed Friday evening, September 28,
after a four-day session at the Royal Palace Hotel, At-
lantic City, N. J.
Unquestionably, this year's meeting will go down in the
annals of the association as one of the most important
ever held. The attendance was large — in fact larger than
was expected because of existing conditions, and the in-
terest at the general sessions, as well as in section meet-
ings, was most keen. Atlantic City is at all times a most
delightful convention city and because of its proximity to
Washington, the center of all national activity at the pres-
ent time, its choice as a meeting place this year was a
most happy one.
As was to be expected, the entire meeting had a dis-
tinctly war atmosphere. Practically every part of the
proceedings dealt with the war program of hospitals and
their relation to the government. If there had been any
doubt in the mind of any one as to where the hospitals of
this country stood in relation to -the present crisis, their
patriotic attitude as manifested throughout this conven-
tion would surely have dispelled such doubts.
Whereas, the meeting at Cleveland last year was de-
voted more to discussions and plans for the future war
program of the hospitals, this year's meeting showed def-
inite progress and offered instructive discussions of the
many problems now confronting hospital administrators.
A noteworthy feature of the week was the first annual
convention of the American Dietetic Association, held in
conjunction with the Section on Dietetics of the American
Hospital Association, which proved a most interesting and
valuable part of the meeting. This association has a most
important field and the interest shown at its initial ses-
sion promises valuable results for the future.
The 1918 convention was featured by a larger commer-
cial exhibit than ever shown at a previous meeting. Hos-
pital superintendents were quick to avail themselves of
the opportunity to examine the wide range of merchan-
dise shown and to discuss with the commercial repre-
sentatives their requirements and problems. The major-
ity of the exhibitors report a very satisfactory business,
as a result. The success of this year's exhibit assures an
even greater showing next year and the Commercial Sec-
tion promises to become the annual market place of the
hospital field.
It was decided that the next meeting of the American
Hospital Association would be held in Cincinnati, Ohio.
The exact dates were undecided, it being planned, how-
ever, to convene some time between September 15 and
October 15, subject to the approval of the Board of Trus-
tees.
GENERAL SESSIONS
Opening Session, Tuesday Morning, September 24
The keynote of the Twentieth Annual Meeting of the
American Hospital Association was Patriotism. This
note was struck in the official program with its decora-
tions in national colors and its portraits of the President
and Secretary of War; in the decorations of the Assembly
Room of the Royal Palace Hotel; in the invocation de-
livered by the Rev. Thomas J. Cross of Atlantic City,
who wore his chaplain's uniform; in the address by the
mayor of Atlantic City, who, in the absence of Governor
Edge, delivered the address of welcome; by the call of
the president of the association for comprehensive and
cooperative action on the part of hospitals in meeting
the present needs of the war; and by the resolution
ofl'ered by the secretary, declaring the purpose of the
THE MODERN HOSPITAL
311
iiinttttiitiniitiiiiiii
"i«££im05tSte0t,.TI0K{. ■' HtllldlttdllKlllilf '
association to support the President of the United States
in the prosecution of the war.
Dr. Ancker's presidential address, which is given in full
on another page, set forth the important issues to be
considered by the American Hospital Association at this
meeting.
The report of the special committee on institutional
membership in the association, of which Dr. A. R. Warner
of Cleveland was chairman, had been previously printed
in full in The Modern Hospital and reprints had been
distributed before the meeting. Dr. Warner, therefore,
considered it superfluous to read the report and called in-
stead for a discussion in order that the debatable points
might be thoroughly covered before any modification of
the constitution recommended by the committee should
tome before the association for action on Thursday.
Mr. Richard P. Borden, a member of the committee,
remarked that the future of the association depends
largely on its financial basis. In order that its finances
may be placed on a sound footing it must have the sup-
port not only of executive heads of institutions but of
the hospitals themselves.
A point which aroused considerable interest was the
committee's statement of its hope "that this change in
the American Hospital Association shall be the first step
in the standardization and classification of hospitals by
this association."
The question of the priciples and methods of this hoped-
for standardization was raised. Dr. Warner replied that
the details of this standardization remained to be worked
out in the future. In reply to a question as to the rela-
tion between standardization by the American Hospital
Association and standardization by the American College
of Surgeons, Dr. Warner replied that there was at pres-
ent no more relation between the work of these two or-
ganizations than there would be between standardiza-
tion attempted by an association of internists or pediat-
rists or ophthalmologists or orthopedists. Any of these
groups have the right to standardize hospitals according
to their own ideas.
Mr. John G. Bowman, director of the American Col-
lege of Surgeons, said that he wished that a better name
could be found for this work than "standardization,"
since this implied enforced similarity. Standardization
he defined as a cross section of the condition of the hos-
pitals of the country, showing the lines where progress
can be made. This work, he said, must include the hearty
support of doctors, hospital superintendents, trustees,
laboratory workers and nurses. It requires the coopera-
tion of all concerned in the hospitals, including the pub-
lic. The American College of Surgeons has taken the
initiative in this work and has spent much money and
eff'ort on it. The college asks the cooperation of hos-
pitals only in so far as the hospitals themselves believe
its program is right.
The question was raised as to the relation which would
exist under the amended constitution between the various
state hospital associations and the American Hospital
Association. Dr. Warner replied that it was expected
that a relation would be worked out similar to that which
exists between the constituent state medical associations
and the American Medical Association. This, however,
remains to be determined.
Other questions raised were the meaning of "other or-
ganizations eligible to membership" and the advantage to
an institution of possessing institutional membership in
addition to the personal membership of its superintend-
ent. In reply to the first question. Dr. Warner defined
"other organizations eligible to membership" as institu-
tions which had as their object the promotion of public
health, and which, contributing to public health, though not
hospitals, had interests closely related to those of hos-
pitals. In reply to the second question. Dr. Warner said
that, while it had not been deemed advisable to bring any
pressure to bear on hospitals to induce them to take out in-
stitutional membership, it was believed that the advan-
tages of being an insider rather than an outsider would
manifest themselves as time went on. In i-eply to the
question as to the relative voting power possessed by
individual and institutional members. Dr. Warner said that
it had been thought best not to deprive active personal
members of the voting privilege. It was thought that an
equitable adjustment had been reached in leaving active
personal members in possession of one vote each and in
312
THE MODERN HOSPITAL
granting to institutional members the I'ight of representa-
tion by three voting delegates each and as many other
delegates with the privileges of the floor, but no vote,
as might be desired. Dr. Warner called attention also to
the machinery which had been devised for making the
association more effective, namely an executive secre-
tary with permanent office and a board of trustees, which
is in effect an executive committee.
Report of the Executive Secretary of the American Hospital
.\SSOClATrON
The report of the executive secretary, including mem-
bership and publicity committee report, follows:
The present Secretary of the
American Hospital Association
has acted in that capacity only
since June 13, 1918. All of his
efforts have been devoted to carrj--
ing out the plans for this Twen-
tieth Annual Convention. On this
phase of the work no detailed re-
port seems necessary at this time.
As chairman of the membership
Committee, the secretai-y is ex-
pected to report for that com-
mittee. It seems necessary only
to make the following statistical
report which has been approved
by the other members of the com-
mittee.
The membei-ship to date shows
the following members in good
standing :
Active 940
Associate 284
Honorary 15
Life 9
The foUowing j
Active
1,248
the delinquents :
210
Resignations :
Active 24
Associate 1
There have been three deaths
during the past year. The office
now has the cards of 52 members
showing no addresses.
From September 1, 1917, to Sep-
tember 1, 1918. 115 new members
have been accepted.
Approved by the Membership
Committee :
Howell Wright.
Sister Genevieve,
Dr. a. W. Smith.
The secretary has also been act-
ing as chairman of the publica-
tion committee. There seems to
be very little to report, however,
except that the plans for the pub-
lication of the proceedings of the
last convention, as set forth by the publication committee, have been car-
ried out. The proceedings have been published and distributed. The com-
mittee believes, however, that in the future more economical arrange-
ments can be made for the printing of the proceedings of each
convention and recommends that careful consideration be given to
any proposals that may be made.
Approved by the Publicity Committee:
Howell Wright.
Dr. H. K. Mohler,
H. E. Webster.
The secretary desires to emphasize to the members of the conven-
tion that no committee has a more important duty this year than the
Time and Place Committee, which is to select the place for the next
convention. Invitations have been received from a number of cities.
They are now in the possession of the secretary, who has been in
correspondence with convention boards and hotels in these various
cities, for the purpose of obtaining information which may be used
OFFICERS OF THE AMERICAN HOS
PITAL ASSOCIATION FOR 1918-1919
PRESIDENT,
DR. A. R. WARNER,
Superintendent Lakeside Hospital,
Cleveland, Ohio.
FIRST VICE-PRESIDENT,
DR. J. B. HOWLAND,
Assistant Administrator
Massachusetts General Hospital,
Boston, Mass.
SECOND VICE-PRESIDENT.
MR. A. B. TIPPING,
Superintendent Touro Infirmary,
New Orleans, La.
THIRD VICE-PRESIDENT.
SISTER IRMENA,
President Missouri Catholic Hospital Association,
St. Louis, Mo.
MR.
TREASURER.
MR. ASA BACON,
Superintendent Presbyterian Hospital,
Chicago, III.
TRr.'^TEE
DR. ROBERT WILSON,
Superintendent Willard Parker Hospital,
New York City
TRUSTEE
MISS MARY L. KEITH,
Superintendent Rochester General Hospital,
Rochester, N. Y.
TKISTEK
MR. RICHARD P. BORDEN,
Fall River, Mass.
by the Time and Place Committee to base its recommendation for the
next convention city
This association spends considerable money at each convention. Its
members and guests spend more. Each year numerous invitations are
received from various cities for the next year's convention. This is
because it is a profitable convention for any city to entertain. The
association, therefore, has a right to expect much in return for holding
its convention in a given city. It is in a position to demand that
all arrangements be on the basis of a business contract. The associa-
tion should pay nothing for convention halls, commercial exhibit space,
or for any purely local matter. In a word, other things being equal,
this association should meet in the city which can make the best
general proposition.
The secretary recommends that the association direct that all data
now in his hands relative to convention cities be placed in the hands
of the Time and Place Committee
and that the committee be in-
structed to go over this data
carefully with the secretary be-
fore making its report to the
convention.
Respectfully submitted,
Howell Wright,
Executive Secretary.
The executive secretary,
Mr. Howell Wright, before
presenting his report,
offered the following reso-
lution, which was enthusi-
astically and unanimously
adopted:
"Be It Resolved, That the Ameri-
can Hospital Association now
assembled in its Twentieth An-
nual Convention, at Atlantic City,
pledge its unswerving loyalty to
the President of the United
States and tender to him its fullest
support and cooperation toward
the successful conclusion of the
Great War in which the Nation
is engaged and the adoption of
the fundamental principles of hu-
manity advanced by him for the
world."
The following message
was received from the
White House, September
25, in answer to this reso-
lution:
ily Dear Sir:
"The President has asked me to-
acknowledge the receipt of your
telegiam of September 24 and to
thank you and those who joined
with you for your generous
expressions of loyalty and sup-
Sincerely yours,
(Signed) J, P, Tumulty,
Secretary to the President.""
The executive secretary
then announced the follow-
ing appointments:
Committee on Time and Place — Mr. Pliny O. Clark,
superintendent Ohio Valley General Hospital, Wheeling,
W. Va., chairman; Mr. F. S. Bunn, superintendent
Youngstown City Hospital, Youngstown, Ohio; Mr.
Asa Bacon, superintendent Presbyterian Hospital,
Chicago.
As Mr. Cornelius S. Loder of New York was the only
member of the committee on accounting present, the fol-
lowing additional members were appointed to that com-
mittee: Mr. Francis Oliver Bates, superintendent Roper
Hospital, Charlotte, S. C; Mr. S. J. Barnes, financial
secretary Orange Hospital, Orange, N. J.; Miss Rosa
Saffeir, superintendent Jamaica Hospital, Jamaica, New
York.
SECRETARY.
HOWELL WRIGHT,
Cleveland, Ohio.
THE MODERN HOSPITAL
313
War Service Program — Wednesday, September 2')
hospitals and medical attention — morning
Before Mr. Boi-den read the report of the war service
committee, the pi-esident appointed a special committee of
nine, to draft and present important resolutions, consisting
of the following members: Mr. Richard P. Borden, chair-
man, Mr. Fred S. Bunn, Dr. J. M. Peters, Mr. Michael M.
Davis, Miss Mary M. Riddle, Mr. A. B. Tipping, Miss
Maude Landis, Mr. R. G. Brodrick, and Mr. Howell
Wright, secretary.
The secretary also read the following communication
from Mr. Benedict Ci'owell, acting secretary of war:
WAR DEPARTMENT
WASHINGTON
September 12, 1918.
To the Officers and Mem-
bers of the American
Hospital Association:
It was with deep regret
that the Secretary of War
was obliged to decline the
invitation to attend the
convention of your associa-
tion on account of projected
absence from the United
States, for he would have
welcomed the opportunity
to meet with you and to ad-
dress you concei'ning some
of the problems which are
of vital interest to both the
War Department and the civil hospitals.
Mr. Baker fully appreciates the difficulties already en-
countered and foreseen by the civil hospitals and is deeply
grateful for the splendid response and cooperation which
has met our every demand thus far. He realizes that the
demands of the War Department have in various ways
seriously aifected the administration of civil hospitals by
the withdrawal of staff physicians, interns, nurses and
employees.
An effort has been made to leave a sufficient number of
physicians for the hospitals to enable them to opei-ate
satisfactorily, but this has been rendered difficult because
of the patriotic spirit which has prompted many to go
in spite of the representations made to them that their
duty was to remain at home. But I need not enumerate
the difficulties which you encounter, for you know them
full well. I am sure that what you wish to know is the
attitude of the War Department as to future protection.
As to physicians, we are aware of their need in civil
as well as military establishments and attention will be
given to the fullest possible extent to such measures as
may be necessary to safeguard the civil hospitals in this
respect.
As to the nurses — the army needs an enormous number,
probably at least .50,000, by next July. While the ma-
jority of the graduate nurses come from other sources
than the hospitals, still I am sure these institutions are
affected to some extent. We have heard m.uch about the
danger of withdrawing so many graduate nurses, but I
ask you to remember that up to this time (the middle of
September) we have withdrawn for military service only
about 16,000 nurses and that during the same time ap-
proximately 25,000 nurses have graduated from training
schools. The subject of how to obtain the requisite num-
ber of nurses has been discussed and numerous plans have
been suggested and some insistently urged. After care-
WHAT THE ATLANTIC CITY CONVEN-
TION ACCOMPLISHED
Showed that the hospitals of the country are
a real and indispensable factor in war service
work.
Adopted a new constitution providing for
institutional membership.
Illustrated the value of meetings at which
hospital superintendents can discuss their
problems.
Successfully presented the largest com-
mercial exhibit ever shown by the association.
Demonstrated the ability of hospital people
to think and plan constructively.
ful consideration, Secretary Baker has approved a pro-
gram which has seemed to him to be the most sound and
constructive of any under consideration, namely, the plan
to supplement the supply of graduate nurses with pupils
of the Army School of Nursing, which he has authorized,
and which the Surgeon General is now putting into ef-
fect. In addition to this, hospital assistants will be used
in the convalescent hospitals in this country. The details
of these plans will, I am sure, be made clear to you by
representatives of the Surgeon General. These plans are
believed to be sound and to be the most satisfactory, both
from the standpoint of the army and as a safeguard to
the civil training school for
nurses. Time will demon-
strate the supplementary
measures to be taken if and
when necessary. The suc-
cess of these plans will de-
pend to a large extent on
your support and avoidance
of all that tends to confuse
the issue. I count upon
and urge your cooperation.
As for the other matter,
which I know to be a real
embarrassment — the short-
age of employees — I wish to
assure you of the interest
and desire of the military
authorities to assist in mit-
igating the difficulty so far
as possible. To this end,
we would welcome suggestions from your association,
for we are aware of the important role which the civil
hospitals play in safeguarding the health of the nation
and in maintaining the morale of the great public at home
while our armies are fighting so nobly abroad.
In conclusion, I wish you to bear in mind that our pro-
gram of five million men under arms by this time next
year, necessitating approximately 500,000 hospital beds
abroad and 200,000 hospital beds in the United States for
army purposes, is a project of considerable magnitude.
Its importance will readily show the need which we have
of the loyal support and cooperation of all interests con-
cerned.
In behalf of the Secretary of War, as well as for myself,
I wish for your association a most successful and profit-
able meeting. g Crowell, Acting Secretary of War.
Mr. Richard P. Borden, secretary of the war service
comittee, presented a report of unusual interest which
elicited prolonged applause. Before reading the report
proper, Mr. Borden displayed a series of charts showing
the method by which the authorities at Washington
sought to arrive at the proper location of the hospitals to
be used for the returned soldiers, on the basis of centers
of population and industry, railroad facilities and medical
and hospital facilities.
In the course of the report, the war service committee
summarized the principles for which it stood in all of its
relations with the war department. The committee con-
tends, first, that so far as possible, existing hospitals
should be used for military purposes as a measure of
necessary conservation of material and personnel; second,
that the hospitals for the treatment of the returned sol-
diers should be located in centers of population; third,
that the physicians at home should be used in these hos-
pitals on part time military service; fourth, that a group
314
THE MODERN HOSPITAL
of volunteer hospital assistants should be created and
trained for service in the home hospitals, both civil and
military.
Mr. Borden's report was followed by a paper by Colonel
Winford H. Smith, representing the Surgeon-General of
the Army, on "The Problems of Medical Education and
the Supply of Medical Interns
and Medical Hospitals," which
is presented in full following
this report.
In the discussion which fol-
lowed Colonel Smith's report,
Mr. F. S. Bunn, of Youngs-
town, Ohio, emphasized the
point that a wise solution of the
general problem could be ar-
rived at only by considering the
civil and army needs as one
problem. This involved, among
other things, the health of the
immediate members of the fam-
ilies of the soldiers sent abroad
and the health of the industrial
worker at home who was back-
ing the soldier in the field
abroad.
Mayor Hayward, of Toronto
General Hospital, who has had
both civil and military hospital
which the Vancouver General Hospital is meeting the
medical needs of civil and military patients. (This is
described by the superintendent of Vancouver General
Hospital, Dr. M. T. McEachern, in one of the leading ar-
ticles in this issue.)
Dr. Goldwater said that there was no logical contradic-
tion between the position of the
war service committee and that
of the Surgeon General's Office.
Already the services of the civil
hospitals had been used for edu-
cational purposes and for the
care of soldiers, and further exi-
gencies would undoubtedly de-
mand that further use be made
of them. He said that he real-
ized how perfectly natural it
was that the Surgeon Gener-
al's Office, faced with the stu-
pendous problem of providing
seven hundred thousand beds
for the use of the army, should
seek the line of least resistance,
but he felt that if the military
had looked with a more friendly
eye upon the suggestions of the
war service committee, an ade-
quate organization could have
been worked out for a wider use
OFFICERS
AMERICAN
HOSPITAL
ASSOCIATION,
1918-1919
President,
Dr. A. R. Warner.
Lakeside Hospital,
Cleveland, Ohio
Secretary,
Mr. Howell
Wright,
Cleveland, Ohio
Treasurer,
Mr. Asa Bacon,
Presbyterian
Hospital,
Chicago
experience, argued that the treatment of the soldier in
civil hospitals was inadvisable because of the dual control
involved and the attitude of the returned soldier toward
the civil doctor who had not seen service abroad.
Mr. Borden sought to correct an erroneous impression
which he felt existed in the minds of some, relating to the
position of the war service committee. He stated that the
committee never advocated the treatment of soldiers in
civil hospitals under civil control. The committee did,
however, contend that by a wise use of civil hospital
space and facilities not now worked to their capacity, both
material and personnel could be saved without in any way
interfering with full military control and discipline.
An interesting account was presented of the wav in
of existing civil hospital facilities. A suggestion which
Dr. Goldwater made, which met with immediate response,
was that in communities where for various reasons the
number of patients in hospitals had diminished, a con-
solidation should be effected, whereby one or more hospi-
tals could be completely turned over to the army.
Because of the amazing power of the local draft boards,
which could not be adequately supervised because of their
very large number and wide distribution. Dr. Goldwater
felt that the convention should formulate very definite
principles for the guidance of these boards in their con-
sideration of the exemption and nonexemption of the per-
sonnel of hospital staffs.
In answer to a question regarding the attitude of the
THE MODERN HOSPITAL
315
War Department toward the resident staff, Colonel Smith
could give no very definite reply, except to say that in-
dividual instances would have to be decided by local
boards. He felt that visiting staffs would have to give
more training to interns and that physicians physically
unfit for army service could fill resident positions.
DR. ROBEET WILSON,
Trustee,
Willard Parker Hospital, New York City
Dr. A. R. Warner, of Lakeside Hospital, Cleveland, in-
quired whether the Surgeon General's Office had formu-
lated any plan under which the physician or surgeon who
refrained from enlisting to remain at his post at home
could with dignity face his returned fellow medical of-
ficers after the war. Colonel Smith replied that the edu-
cational committee of the War Department was planning
•to do something about this as far as members of the teach-
ing staffs were concerned, but this did not meet the situa-
ation of the rank and file of hospitals. An alternative
proposition which had been considered was the drafting of
the entire medical profession, each district being then
asked to furnish its quota of men, a system which now
prevails essentially in England. Thus far, however, no
definite plan had been placed in operation.
During the course of the session the following resolu-
tion by Dr. Goldwater was unanimously adopted:
"Resolved, That the American Hospital .\ssociation hereby express
to the Secretary of War, the General Staff, and the Surgeon General of
the United States Army, its grateful appreciation of the opportunity
that has been given to its representatives during the past year to
consult with the government in promoting the adoption of a medical
program adequate to the needs of the country during the war ; and
Resolved. That the association hopes and trusts that the cordial rela-
tions already established may continue, to the end that the welfare both
of the militarj- and civil population may be conser\'ed and promoted."
RECONSTRUCTION AND REHABILITATION
The secretary called attention to the fact that for the
first time in the history of the association the president
had invited the states to appoint official delegates and
that thirty states had responded; also that the letter of
the president to boards of trustees, urging that hospitals
send official delegates to the annual meeting and pay the
expenses of these delegates, had proved well worth while
and such a measure would be found most useful for the
future.
Dr. 0. F. Ball, president of the Modern Hospital Pub-
lishing Company, presented the following resolution:
Be it Resolved, That we, the members of the American Hospital
Association, gratefully acknowledge the message of good will extended
to us by the Catholic Hospital Association at its recent .annual conven-
tion ; that we congratulate the association on its expressed action look-
ing toward hospital advancement and a broadening of institutional
service to the sick: and that we heartily desire that the bonds of our
common aims hold the associations in close cooperation.
The resolution was unanimously adopted.
Mr. C. A. Prosser, director of the Federal Board for
Vocational Education, Washington, D. C, who was to
have read a paper on "The Federal Vocational Board and
the Civil Hospitals," was unable to be present, and his
paper was not read. Mr. T. B. Kidner, vocational secre-
tary of the Invalided Soldiers' Commission of Canada, who
has been lent by that commission to the Federal Board
for Vocational Education, spoke briefly on behalf of Mr.
Prosser before reading his own paper.
Mr. Kidner said that it had been found not enough to
give the disabled man a medal, a pension, a "God bless you
MISS MARY L. KEITH,
Trustee.
Superintendent Rochester General Hospital, Rochester, N. Y.
— get out," The new idea was to make the man better
morally ^nd socially because of his experience and to re-
habilitate him so that he could take his place as a self-
sustaining and self-respecting member of society. For
this not only medical treatment of the old kind but also
occupational therapy had been found necessary. The-
316
THE MODERN HOSPITAL
Federal Boai-d for Vocational Education had been in-
structed by the government to cooperate with the Federal
Department of Labor. In one respect the measures for
vocational reeducation adopted by the Federal govern-
ment are ahead of those of any other country. In other
countries the disabled man who cannot return to his form-
COL. WINFORD H. SMITH.
Repi-esentine the Surgeon-General's Office at the Atlantic City
Convention
er occupation receives free vocational reeducation and
maintenance during the period of his training. The United
States will give free vocational training not only to the
man who cannot return to his former occupation but also
to the man who is capable of resuming his previous work.
He will not, however, receive maintenance during the
period of training.
Mr. Kidner then read his own paper on "Canada's Re-
habilitation and Reconstruction Work," which will be pub-
lished in full in a later issue of The Modern Hospital.
Mr. Kidner's paper was followed by motion pictures show-
ing the reeducational work done in Canada. Incidentally,
Mr. Kidner remarked that it had been feared that after
his life in the open a soldier would not readily return to
vocations which took him away from the land. This, he
said, was a mistake. He quoted one soldier who said, "I
have had enough of the land. It has been in me boots,
me hair, and me grub. Me for the steam heat and the
white lights." Mr. Kidner also called attention to the
fact that the Bankhead bill, now before Congress with
good chances of passing, provides for the reeducation of
the industrially crippled somewhat on the same lines as
the Smith-Hughes bill provides for the reeducation of the
war crippled.
Mr. Douglas C. McMurtrie, director of the Red Cross
Institute for Crippled and Disabled Men, New York City,
delivered his address on "Social Considerations in the Re-
habilitation of the Disabled," illustrated with motion pic-
tures, which will also be published in a subsequent issue
of The M iDER.N' Hospital.
NURSING PROBLEMS — EVENING
When Dr. Ancker opened the Wednesday evening meet-
ing and turned it over to the presiding officer of the eve-
ning, Miss Georgia M. Nevins, chairman of the section on
nursing, the main assembly hall was already filled to
capacity with an audience keen to hear about the national
nursing problems. A spontaneous burst of applause greet-
ed the introduction of Miss Annie W. Goodrich, dean of
the Army School of Nursing (representing the Surgeon
General of the Army) who read a paper on "The War De-
partment Program for the Nursing Care of the Army,"
which will appear in a subsequent issue.
In the absence of Miss Mary Beard, the president of the
National Organization for Public Health Nursing, who
was on the program for a paper on "Public Health and
Nursing of the War" the paper was read by title and
Mrs. Helen Hoyt Greely, counsel for the National Com-
mittee to Secure Rank for Nurses, was given an opportun-
ity to present the issues involved in the desire of nurses
for military rank and to urge support of the Lewis-Raker
bill, giving rank to nurses. Mi's. Greely pointed out that
rank was desired by the nurses in order that they might
use it as an instrument of efficiency and not as a matter
of convenience to themselves. Among the tens of thou-
sands of orderlies in the various military hospitals, many
were not instructed in respect for the nurses and, in the
absence of any outward visible sanction of authority, the
nurses were subject to many humiliations at the hands of
the orderlies. Mrs. Greely pointed out that Canada and
Australia have rank for nurses from major down to sec-
ond lieutenant, and urged that we follow their example.
The adoption of the following resolution was then
moved by Dr. A. R. Warner, of Cleveland, and was en-
thusiastically adopted :
Whereas, Under the present system the right of nurses of the
.\rmy Nurse Corps to exercise authority over enlisted men assigned to
liuty in military hospitals is frequently disputed by hospital corps men,
ward masters, and noncommissioned officers, because the status of the
nurses is not well understood and their position and powers are
described only in regulations in books not familiar to the men : and
Superintendent, Ohi
MR. PLINY O. CLARK.
Valley General Hospital, Wheeling, West Virgil
uthority results not
ale but frequently in
.nly in
serious
Whereas, This questioning of their
unfortunate friction and a disturbed n
delay in the execution of important orders : and
Whereas. Enlisted men have learned through instruction and disci-
pline in established army practices to look for and respect the external
evidence of authority in the insignia of rank ; and
THE MODERN HOSPITAL
317
Whekeas, The conferring of rank upon nurses would place upon them
that outward badjre of authority so essential in a democracy where one
does not by nature talie orilers unless assureil of the unquestioned rifiht
of another to give them : and
Whereas. There is before Congress a bill contemplating the confer-
ring' of relative rank upon nurses ; and
Whereas, This relative rank does not involve the actual commission-
ins of nurses, nor give them the pay, allowances or emoluments of
the rank, nor yet the power of command incident to a line officer of
similar grade, but gives only the right to wear the insignia of the
rank and eligibility to exercise authority only in medical and sanitary
mattei-s and other work in the line of their duties in and about mili-
tary hospitals next after the medical officers of the army ; and
Whereas, The conferring of certain relative rank upon the nurses
would greatly contribute to the efficiency of their service ; and
Wheseas. The experience of the Australians and the Canadians, both
of whom have conferred relative rank upon their nurses, has demon-
strated the wisdom of drawin? an unmistakable line of demarcation
between nurses and enlisted men and of classing all nurses with officers:
therefore be it
Resoh^ed. That we heartily endorse the conferring of relative rank
upon nurses : that we deplore and condemn the idea of conferring upon
any nurse any rank lower than of a second lieutenant ; and that we
urge the immediate passage of the Lewis-Raker bill, which proposes
rank as follows : For the superintendent of the army nurse corps, rela-
tive rank of major. For the assistant superintendents ; directors and
assistant directors, relative rank of captain : for chief nurses, relative
rank of first lieutenant: for nurses, relative rank of second lieutenant;
and be it further
Resolved. That a copy of these Resolutions be sent to the President
and Vice President of the United States, the SecretaiT of War. the
Secretary of the Navy, the Surgeon Military Affairs of both the Senate
and the House of Representatives.
The resolution was unanimously adopted.
The subject of "The Red Cross Nursing Service" was
presented by Miss Jane A. Delano, director of the Depart-
ment of Nursing, American Red Cross, whose paper also
appears in this issue.
The last paper of the evening- was that of Miss Adelaide
Nutting, of the Teacher's College, Columbia University,
who is acting as chairman of the Committee on Nursing,
Council of the National Defence. Miss Nutting's paper
appears in this issue.
Mr. Richard P. Borden, who was called upon by Miss
Nevins, the chairman of the meeting, to open the discus-
sion, questioned the wisdom of some of the plans that had
been outlined in the papers that had been read. He con-
tended that if the plans for the Army Training School for
Nurses were carried out on a large scale they would seri-
ously handicap the civil hospitals, since many of the latter
are already suffering from the lack of trained supervisors.
Just as we are sending millions of men to the front to
do a particular piece of work, so, he said, women who are
anxious to do their bit but who have no desire to enter
the nursing profession should receive special education in
their particular line of duty instead of being required to
take the full nurse's training course. He contended for a
wide use of hospital assistants trained on a standardized
basis. He regretted that the program supported by the
previous speakers had been adopted without due consulta-
tion with civil hospitals.
Miss S. Lillian Clayton, of Philadelphia, replied that the
plans for affiliation of the Army School for Nurses with
the civil hospitals had not been adopted without consulta-
tion with the civil hospitals, and referred to resolution of
endorsement adopted at the last meeting of the national
nursing organizations.
Dr. C. O. Young, of Chicago, a delegate sent by the gov-
ernor of niinois, asserted that, notwithstanding the reso-
lution referred to, the hospitals themselves, their boards
of trustees, etc., had not been consulted.
Dr. S. S. Goldwater, of New York, said that he did not
despair of the ultimate outcome of the nursing problem
when he saw the army, step by step modifying its plans
to meet the actual needs as thev arose from time to time.
He sketched the three stages through which the problem
of supplying the army with an adequate nursing service
had passed. The first step involved the enrollment of
graduate nurses; the second the launching of the Army
School for Nursing, which he characterized as a well-in-
tentioned purpose but rather loosely organized; and finally
the adoption of a plan for the education of hospital assist-
ants.
In speaking of the Army School for Nursing, he dwelt
upon the inadequate clinical material which the army
hospitals afl'orded and showed how it led to the first modi-
fication of the plan, namely, the affiliation of civil hos-
pitals. He felt that the difference between the civil
schools and the army schools in the spquence pupils are
admitted, presented a difficult problem from the stand-
point of organization. He felt that the plan was danger-
ous from the standpoint of downright morality, when it
is not known what resources we have for the training of
these women. Dr. Goldwater felt that now that the third
step had been taken, namely, the adoption of the plan of
training hospital assistants, the only difference between
the two opposing schools on this subject was the question
of what should be the relative proportion between the
graduate nurse, the pupil nurse and the hospital assistant.
It was Dr. Goldwater's opinion that if the v/ar continues
very long, hospital assistants will have to be used very
freely in both civil and military hospitals.
Morning, September 26
The report of the Committee on Institutional Member-
ship, which has already been published in The Modern
Hospital, was presented, and adopted with one amend-
ment, offered by Mr. Richard F. Borden. The adoption
of this measure is one of the most important achieve-
ments of this meeting.
Mr. Michael M. Davis, Jr., chairman of the Committee
on Out-Patient Work, read the report of that committee,
which was adopted. The report of this committee will
be published later in The Modern Hospital.
Mr. N. V. Perry then read a paper on "Hospital Con-
struction," illustrated with lantern slides. This will also
appear later in this journal.
Evening, September 26
One of the most interesting, practical, and successful
sessions held during the entire convention was not sched-
uled on the program — one at which no papers were read
and no resolutions presented. Mr. Asa Bacon, superin-
tendent of Presbyterian Hospital, Chicago, elected chair-
man of this meeting, held Thursday evening, stated that
the purpose was to take the place of a question box.
Dr. Moss, of Baltimore, presented five questions: (1)
How can we get and keep domestic help? (2) How can
the shortage of interns be made up? (3) Considering
increase in expense, how can we increase our income ?
(4) How can we supply the shortage of orderlies? (5)
Shall the hospital receive those applying for rest cures ?
(1) Among the replies to the first question were the fol-
lowing: "Introduce machinery. Set up cafeteria for help."
"Feed them better." "Furnish proper housing, feeding
and pay." "We have a welfare worker and all kinds of
amusements." "Munitions workers get $7 a day. Hospital
offers $35 per month." "We use Japanese help." "Govern-
ment should regulate these high wages." "Tuberculosis
hospital u=!es improved patients; pays them $20 to $30 per
month." Mr. Test, of Philadelphia, asked, "Why not get
volunteer help, both men and women? I have a society
girl who works from 6 a. m. to 6 p. m. six days a week."
Others suggested, "We have a volunteer working to re-
318
THE MODERN HOSPITAL
lease graduates." "We have a volunteer making- dress-
ings." "Society voluntary help is irregular." "We use
half crippled men, at $40 per month." "Hospitals should
be classed as essentials." "We have volunteers making
dressings and sewing." "We use old men and handicapped
men." "Prohibition will help." "Eight-hour day, $35 to
$45 per month."
(2) The question about the method of meeting the
shortage of interns was answered by St. Luke's, Cleve-
land, to the effect that half the usual number of interns
did full work when paid. Another institution expects the
compulsory intern year to cover the need.
(3) The question in regard to ways of increasing in-
come was answered as follows: "Exchange garbage for
soap." "Charge more." "Charges in Providence have
already been raised from $12 to $17.25 and from $21 to
$24.50." "Presbjterian Hospital in Chicago has made
a small raise in wards, 25 cents a day, and a large raise
in private rooms." "Set a daily rate and not a lower
rate. Give charity outright." "We increase our income
by using the interns private dining room. We forced
county to raise pay from $1 to $2 per day." "It is
possible to get more money from ward patients. Our
investigator saved us more than three times his salary
by close investigation." "Investigate all departments
closely to shut off waste." Various reports were made
on per capita cost for ward patients, including $1.64 per
day in California, $1.59 in South Carolina, $2.10 and $2.67
in Pennsylvania, $2 in Oklahoma, $2.16 in Toronto, Can-
ada, $2.25 in Ohio, $2.85 in Chicago, and $3.50 in New
York. The question, "What does per capita cost mean?
What do you give?" brought out that the x-ray charge
in Chicago varied from zero to $25, and that operating
room charge varied from $2.50 to $15. The suggestion
■was made to adopt a uniform x-ray charge according
to plate, charging war patients one-half. A second sug-
gestion was to place all x-ray workers on salary and let
the hospital get the profit. Other suggestions were to
charge at cost for drugs, etc., and to make daily charge
cover free dressings and medicine. Maternity cases are
charged all the way from $1 per day to $2.75. Most hos-
pitals charge from $1.50 to $2 per day with no charge
for entrance. Some hospitals charge 50 cents per day
:for new-born babies, and others from $5 to $7 per week.
(4) Among suggestions as to the way of meeting the
shortage of orderlies were: "Get older men." "Replace
men with women, as far as possible." "Get the government
to lend us soldiers to train." "Get professors and school
masters." "One hospital is trying high school students."
^'Employ aliens." "Substitute women and children."
Montreal Hospital has eliminated indoor orderlies.
(5) Shall the hospital receive those needing the rest
cure? Few say shut them out; few say take them in;
the rest are indifferent. Mr. Test says, "Treat patients
as normally as possible, taking all that require hospital
care, no matter what their complaint may be."
A query was presented by a puzzled business man,
■"What can a hospital having no dispensary do in the
venereal disease campaign?" The only answer was, "Open
one." He was finally referred to expert headquarters.
This query brought out the fact that Mr. Michael M.
Davis Jr., says most of this woi-k must be done in small
towns. Mr. W. J. Clark, Columbia, S. C, says the govern-
ment furnished a needed dispensary. Others say that
the local health officer should. The business man said that
the attitude of the local practitioner was discouraging to
the hospital; therefore, the trustees were afraid to under-
take the expense. The doctors were cynical or antagon-
istic. As to the question of reporting venereal disease,
they felt the publicity in small towns to be feared, which
made a deadlock in small communities. He was told that
any health officer can compel treatment of quarantine.
Quotations as to salaries of night supervisors ran from
$50 to $85 per month; of head nurses, from $65 to $100
per month. Interns are receiving fi-om $10 to $150 per
month. Nurse anesthetists from $1,000 to $2,000 per
year. This raised the question of the responsibility of
nurse anesthetist and medical student anesthetist. The
employment of nurses anesthetists is legal in Pennsylva-
nia, illegal in Providence, R. I. Nurses are good as anes-
thetists. Employer of a nurse really should be respon-
sible.
Morning, September 27.
The secretary announced that 483 members, delegates
and guests had registered. This number, together with
the commercial exhibitors, who numbered 100, made a
total registration of 583. Thirty-four states were repre-
sented. Pennsylvania had the largest representation, 76,
while New York came second with 58. There were 99
delegates present, who were appointed by the governors
of 26 states. The representation from west of the Mis-
sissippi River was most gratifying.
The secretary called attention to a letter which he had
received from the Fuel Administration urging the con-
servation of fuel by the hospitals of the country.
Mr. Howell Wright, chairman of the Standing Com-
mittee on Legislation, read the report of that committee,
which is presented elsewhere in this issue.
One of the most interesting and insti'uctive papers of
the convention was that on "Hospitals and Health Insur-
ance," by Mr. John A. Lapp, the director of investigation
of the Ohio Health and Old Age Insurance Commission,
which will be published in The Modern Hospital.
In the discussion of Mr. Lapp's paper the convention's
attention was called to the fact that one of the large
mutual insurance companies is considering the establish-
ment of hospitals of its own, in communities where there
were large numbers of insui'ed, because they found they
could get better service at less expense than in general
hospitals. Mr. Barrow B. Lyons, of Wilmington, Dela-
ware, presented an interesting analysis of the reasons
why he thought people desired to be in control of hos-
pitals: (1) because they were anxious to relieve physi-
cal suffering; (2) because they were anxious to relieve
future suffering by raising the health standai'd of the
community; (3) because they desired to win social recog-
nition; (4) because they liked to exercise authority: (5)
because they wish to win a place in Heaven!
Mr. Frederick Greene, of the United Hospital Fund of
New York, showed how, by an analysis of statistics which
the fund had secured from forty-six leading hospitals
which were members of the fund, facts had been secured
which were very helpful to the hospitals in enabling them
to secure a fair payment for the services which they
rendered to the community.
Mr. Lyons thought it was within the power of the asso-
ciation to bring before the public those cases in which
insurance companies are delinquent in settling their ac-
counts with hospitals.
Following the discussion of Mr. Lapp's paper, Mr. Bor-
den, the chairman on resolutions, presented ten or eleven
resolutions, all of which were unanimously adopted and
appear elsewhere in this issue of The Modern Hospital.
The report of the Nominating Committee was read by
(•olonel Lewis R. Baldwin, Minneapolis, chairman of the
Standing Committee on Nominations. The committee
THE MODERN HOSPITAL
319
made the following nominations: President, Dr. A. R.
Warner, superintendent Lakeside Hospital, Cleveland,
Ohio; first vice-president. Dr. Joseph B. Rowland, acting
superintendent Massachusetts General Hospital, Boston;
second vice-president, Mr. A. B. Tipping, superintendent
Touro Infirmary, New Orleans, La.; third vice-president.
Sister Irmena, president Missouri Catholic Hospital
Association, St. Louis; treasurer, Mr. Asa Bacon, Chicago;
executive secretary, Mr. Howell Wright, Cleveland, Ohio;
trustee for five years, Dr. Robert J. Wilson, Department
of Health, New York, N. Y. These men were unani-
mously elected to their respective offices for the coming
year, the question of Mr. Wright's salary as executive
secretary being referred to the board of trustees.
Dr. Warner, in accepting the presidency, stated that
he could not conceive of any election that could give him
greater satisfaction than his election to presidency of the
.American Hospital Association. He felt that the election
was more than an ordinary honor, as it was more than
he had reason to expect, inasmuch as last year he had
refused the nomination without giving his reasons for
doing so.
The concluding paper of the Friday morning session
was one by Dr. Warner, devoted to the subject of social
service and hospital efficiency, which is published in
The Modern Hospital. Dr. Warner stated that social
service to be efficient required a thorough knowledge of
the medical questions involved; a far-reaching knowledge
of sociology; and a mature judgment of what is best to
be done in given cases. In conclusion, he urged that uni-
versities be persuaded to give special courses in hospital
social service work. This recommendation was embodied
in the following resolution, which was unanimously
adopted:
Resolved, That the American Hospital Association express a recogni-
tion of a general need of a large number of women to supervise hos-
pital social service work, who shall have the advantages of training by
a university in preparation for such work ; that the essential elements
in such an education are (1) general educational; (2) medical: (3)
sociologic ; and that this work be so combined as to make a university
course of reasonable length : and be it further
Resolved, That the executive secretary shall send copies of this reso-
lution to such universities as do now give practical courses in philan-
thropy and sociology and to any other universities contemplating the
establishment of such
Evening, September 27
The Friday evening meeting, which was a joint general
session of the American Hospital Association and the
American Dietetic Association, was called to order by
Dr. Warner, the president-elect of the American Hospital
Association.
The seci'etary announced that a communication regard-
ing the newly established institutional membership, would
go out to the membership of the association as soon as
possible.
The report of the auditing committee was read by Mr.
Cornelius S. Loder and accepted by the association.
This was followed by the report of the Committee on
Time and Place. This committee reported that, after
taking account of the factors of accessibility, accommo-
dations for exhibitors, hotel accommodations and hos-
pitals and entertainment, it recommended: (1) that the
invitation of the city of Cincinnati, Ohio that next year's
convention to be held there, be accepted; (2) provided
that, if in the judgment of the board of trustees of the
association another city proves more desirable, the board
of trustees be given authority to make the change; (3)
that the board of trustees be empowered to set the time
of the convention between September 1 and October 15,
1919, as it may think best. This report was unanimously
accepted.
In very happy language, Mr. Daniel Test, referring to
four hospital superintendents who, at the beginning of
his career as a hospital superintendent had been exceed-
ingly helpful to him, paid Dr. Ancker, who was one of
them, a glowing compliment on his work for the associa-
tion during the past year. On behalf of the association,
Mr. Test also expressed appreciation to the secretary,
the treasurer, the trustees, and the chairman of the war
service committee of the association, as well as to the
public press, the local committee and the mayor of At-
lantic City.
At the conclusion of Mr. Test's speech, the meeting
was turned over by Dr. Warner to Miss Cooper, the vice-
president of the American Dietetic Association.
Mr. Henry C. W^right, the secretary of the New York
State Charities .A.id Association, addressed the convention
on the subject of institutional food conservation, and told
of the work of the division of the National Food Admin-
istration dealing with the conservation of food in institu-
tions and college dining halls. Speaking broadly, he
dwelt upon the two main subjects of the readjustment of
the dietary and how to save food as well as readjust the
dietary. He commended the policy of the government in
conserving food by the voluntary effort of the citizens of
the country. He felt that the results in food conservation
were a demonstration of what a democratic people can
do when they think it ought to be done. The government,
after establishing its program of food conservation, was
obliged to take the next step and show the people how food
could be conserved. This resulted in the appointment of
a number of committees, of which the committee dealing
with institutions, both public and private, and college din-
ing rooms was one.
The main food items which the government has asked
institutions to save are wheat and wheat products, meats,
fats and sugars. As conditions in different parts of the
United States vary, and as food varies w-ith the seasons,
no specific recommendations could be made by the com-
mittee for general application. The committee therefore
collected a group of well known dietaries which are being
sent to various institutions of the country as illustrative
of the way in which the use of these main food staples
may be reduced.
In developing the question of how food can be saved
Mr. Wright contended that in order to save food it is of
prime importance for the superintendent of the institu-
tion to know- how much food comes from the storeroom,
how much comes out of the kitchen and how much goes to
the service rooms. He referred to a pamphlet which will
shortly be issued by the government describing a waste
system which has been used successfully in a number of
states and which has proved practical and exceedingly
economical. In concluding his remarks, Mr. Wright re-
ferred to the cafeteria system as a possible means by
which institutions may conserve food.
Mr. Pitcher of Kings Park State Hospital, Kings Park,
L. I., then read a paper on the subject of waste in the
preparation, cooking and serving of food. The paper pre-
sented a variety of valuable detail on this subject and will
be published in a later issue of this magazine.
Miss Lulu Graves, editor of the Dietetics Department of
The Modern Hospital, then read her paper on "The
Management of the Dietary Department of the Hospital,"
which will be published in a later issue of The Modern
Hospital.
Following a very brief discussion of Miss Graves' paper
Miss Lenna Cooper of the Battle Creek Sanitarium said:
"It may be that I shall throw a bomb into the camp
when I say that, on top of the demand for nurses and
surgeons for the army which has been made upon hos-
320
THE MODERN HOSPITAL
pitals, there is a strong possibility of the necessity of hos-
pitals sparing their dietitians. Either the civil hospitals
must spare their dietitians or others must be found very
quickly."
Miss Cooper then introduced Miss Fisher of Teachers'
College. Miss Fisher said
that the Dietitians Com-
mittee of the Nursing
Section of the American
Red Cross expected hos-
pitals which now took
student dietitians to take
more, and expected the
others who did not take
student dietitians to make
provisions to do so. She
said that the committee
recommended a four
months' course, informa-
tion regarding which
Mr. Asa Bacon, superintendent of the Presbyterian
Hospital, Chicago, reported that his institution had, as a
patriotic duty, increased its nursing school by 25 per cent.
"We moved our maids into two houses in the rear of the
home and gave their beds to pupils. At present we have
26 nonresident pupils pay-
ing their own room rent.
We are able to provide
sufficient training for this
increase without lowering
the standard. We have
sufficient pupils booked to
1920. So far the nonresi-
dent plan has been quite
satisfactory under the
supervision of the princi-
pal of the school." In re-
sponse to questions, Mr.
Bacon said that the Pres-
byterian Hospital had in-
Commercial
Exhibits.
Atlantic City
Convention,
American
Hospital
Association
would be gladly furnished by Miss Elva George, director
of the Dietitian Service of the American Red Cross.
CONVENTION FEATURES TO BE DESCRIBED LATER
Next month will appear a comment on the commercial
exhibit; also a complete report of the meeting of the
.American Dietetic Association and the section on dietetics
of the American Hospital Association. Some of the papers
read in the general and section sessions appear in fol-
lowing pages of this issue; others will be published in
later issues of The Modern Hospital.
SECTION MEETINGS
Section on Nursing
Tuesday Afternoon, September 24,
Miss Georgia M. Nevins, chairman of the section and
director of the nursing bureau, Potomac division, Ameri-
can Red Cross, presided.
Miss Mary M. Riddle, superintendent of the Newton
Hospital, Newton Lower Falls, Mass., author of the first
paper on the program, called "How to Secure the Best
Results for Students for Those Schools Which Have
Patriotically Increased Their Nurses on Account of War
Conditions," was not present, and her paper was therefore
read by Miss Jessie L. Catton of St. Luke's Hospital, St.
Paul, Minn. Miss Riddle's paper will be published later.
The chairman then asked how many superintendents
present represented hospitals which had patriotically taken
a larger number of nurses than would have been needed
under ordinary conditions. The number of hands raised
indicated that a considerable number had taken on an
increased number.
creased its school facilities in the occupational and
other departments and that no trouble with discipline
had resulted from the admission of nonresident stu-
dents.
To the question whether anyone had permitted student
nurses to remain in their own homes. Miss C. Irene Oberg
of Elgin, 111., responded that two students in her school
were living in their own homes.
The point having been raised that, as in other schools,
the nonresident students were less likely to become imbued
with the spirit of life in the school, Mrs. Helen DeSpelder
Moore of Jackson, Mich., reported that their one stu-
dent nurse permitted to remain in her own home was one
of the most enthusiastic supporters of the school life and
activities.
Miss Mary L. Keith, superintendent of Rochester Gen-
eral Hospital, Rochester, N. Y., then read a paper on
"Triple Alliance of Nursing Interests." Miss Keith de-
scribed an educational experiment instituted in three
schools of Rochester which had problems in common.
Hospital 1, an institution with 280 beds, had lost its super-
intendent of nurses, its practical instructor, its night
supervisor, its operating room supervisor and its social
service secretary. Hospital No. 2, with 150 beds, had
parted with its superintendent of nurses to the army
service and promoted its instructor to the vacant position;
it had also lost its operating supervisor and maternity
head nurse. Hospital 3, with 140 beds, had made sweep-
ing changes in management. A new superintendent of
nurses was trying to raise a first-class school out of ashes
of a third rate school.
THE MODERN HOSPITAL
321
The problem that confronted the three schools was,
although no first-class instructors could be obtained for
love or money, to take in, as a patriotic duty, more pro-
bationers and train them better and more rapidly, and
to maintain higher efficiency than ever before. It was
decided, as a first step in the solution of this problem, to
pool the assets and liabilities of the three institutions, so
far as the preliminary course of instruction extending-
over thirteen weeks was concerned, with the motto, "All
for each and each for all." Each school accepted its own
probationers for the September course. No. 3 accepted
twenty-one. No. 2 twenty-four, and No. 1 thirty-five, mak-
ing eighty in all. Of the three schools No. 3 had had a
systematic course and was ready for any progressive
step. No. 2 had one instructor for both theory and prac-
tice. No. 1 had an embryo practical instructor and was
about to lose its theoretical instructor. This theoretical
instructor had unusual qualifications, including college
preparation, but after four years' work in the school of
the hospital, she advanced to the limit of all that
institution had to offer in either money or experience and
was ready for larger fields. She was released from resi-
dence at the hospital and from all routine, except that of
academic instructor, and was re-engaged as director of
instruction for the three schools.
The largest school pays half of her salary and the other
two pay one-quarter each. This director now lives in a
cozy little suite in a central locality and goes forth thence
each week-day to teach. Her first class begins at 9 a. m..
and her last one ends at 5 p. m., except on Saturday, when
the hours are shorter. She takes time for lunch and gets
air and exercise going from one hospital to another. Her
evenings and Sundays are free. Each hospital has a
resident graduate assistant instructor and each of these
assistant instructors has as her assistant a third-year
pupil. It is a great honor to be chosen as a student assist-
ant instructor, and the selection is very carefully made.
The assistant thus chosen is receiving training for teach-
ing work. As the student assistant is changed from time
to time, there are each year several pupil nurses receiving
training for teaching positions on graduation.
The director has full control of all assistants and plans
all the schedules. This is the hardest part of the work.
Each school has its own class room, and the standardized
equipment is the same in all ; so also are the methods of
procedure taught. The note which is most loudly and
most frequently struck in all the teaching, is that all
theory is to bear out practice and that no theory is of
value unless it can be used.
' The experiment has been more than a demonstration of
the value of cooperative teaching. It has also been a
study in ethics and psychology and sociology. Within
Miss Keith's memory, the superintendents of these several
hospitals were not on speaking terms with each other, and
the three institutions, as a matter of course, practiced
destructive competition. The fact that cordial and friendly
relations are now maintained among the three schools is
perhaps the more striking because of the fact that one
institution represents the regular school of medicine, while
the other two are the Hahnemann Homeopathic Hospitals.
The beginning of the experiment in cooperation prob-
ably dates back to 1917, when Hospital No. 1 lost its
laboratory forces to the army. There was no one to do
the work, and the laboratory and equipment deteriorated.
One of the hospitals had a pathologist and two technicians,
money and equipment; it had nothing tangible to gain by
affiliation. By action of its board, however, it did affil-
iate with the needy hospital and its pathologist became
the pathologist of the two hospitals on a fifty-fifty basis.
The pathologist selected and trained two technicians for
the hospital which had lost its force. Now in case of
exigencies the forces of the two hospitals are used inter-
changeably.
Miss Flaws of Toronto, Canada, reported that in her
city eight schools had combined to train their stu-
dent nurses, not, however, during their probationary
period. In the senior year social service and pediatrics
were given on a cooperative basis; in the intermediate
year, surgery and gynecology, and in the junior year bac-
teriology and medicine.
Miss Nevin, chairman of the section, made the point
that this cooperation among schools of nursing meant
getting away from petty and ridiculous jealousy and to-
ward the factor which is looming so large in the future
of hospitals, namely, standardization.
As Miss Isabel M. Stewart, of Teachers' College, was
not present, her paper on "The Vassar Training Camp"
was not read.
Afternoon. September 27
A paper on "The Summer Course at Western Reserve
University," by Miss Claribel A. Wheeler, principal of
Mount Sinai Hospital School of Nursing, Cleveland, Ohio,
was read in the author's absence. This paper will be pub-
lished in The Modern Hospital.
In discussion on this paper, Miss Maude Landis, of New
Haven, Conn., outlined work which is being done to raise
the standard of the Connecticut Training School.
Miss Harriet Frost, head of the teaching department of
the Visiting Nurse Society, Philadelphia, then read a
paper on "The Training of Third-Year Students in Public
Health Nursing," which will appear in a later issue of this
journal.
In reply to a question from Miss Nevins in regard to
the way in which the training of pupil nurses is done,
Miss Frost replied that two months' training is given
now and four months is hoped for. Most pupils live at
their own hospitals.
Miss Mary E. Lent, director of nurses. United States
Public Health Service then read her paper on "Public
Health Work in the Sanitary Zones."
This was followed by the paper of Miss Isabel M. Stew-
art, of the Department of Nursing and Health, Teachers'
College, New York, on "The Vassar Training Camp,"
which had been omitted from the Tuesday session. It
will appear in a later issue.
Sections on Out-Patient Work and Social Service
Joint Meeting, Tuesday Afternoon, September 24
Noteworthy because of its spirited speeches and dis-
cussion was the meeting on Tuesday afternoon of the
Sections on Out-Patient work and on Social Service, which
were combined because of the unavoidable absence of Mr.
John E. Ransom, superintendent of the Central Free Dis-
pensary, Chicago, who was acting as chairman of the Sec-
tion on Social Service. Mr. Michael M. Davis, Jr., chair-
man of the Section on Out-Patient Work, presided. The
subject under discussion, "Fighting Venereal Diseases:
A National Program Calling for Dispensary Service," was
handled in a very able, spirited manner by Maj. Alec N.
Thompson, who represented both the Surgeon-General of
the Army and the United States Public Health Service.
Major Thompson sketched the inception of the move-
ment which led to the adoption of a nation-wide progi-am
for the ontrol of venereal diseases as a war measure.
As part of this program the Surgeon-General has invited
the various states to avail themselves of the offer of the
I'ederal government to place an officer especially trained
322
THE MODERN HOSPITAL
in venereal disease work in each state department of
health. The government, moreover, has passed the
Chamberlain-Kahn bill, providing $1,000,000 for the pur-
pose of subsidizing the venereal disease control work in
the various states. This year the subsidy is based on
state population. Next year, however, it is proposed to
subsidize each state on the basis of what it is willing to
invest in this work.
Major Thompson indicated that the national program
involved the development of diversified public health
activities, including the reporting of acutely infectious
cases, the detection of carriers, the isolation of "incor-
rigibles," treatment facilities in hospitals and dispen-
saries, the education of the public, adequate laws and the
strict enforcement of those laws. The whole program
was based, he stated, on the principle that continence is
compatible with health and the best preventive of
venereal disease. He urged the hospitals to cooperate in
carrying out this program by opening their doors to
patients suffering from these diseases, declaring that any
institution which refuses to treat venereal disease is not
doing its bit. He quoted some figures showing that, dur-
ing the last nine months, 39,425 cases of venereal disease
existed in the army, only 4,106 of which were contracted
after enlistment. He contended that if the men had had
hospitals and dispensaries to which they could have gone
for treatment instead of only quacks and drugstores this
number might have been greatly reduced.
Major Thompson dwelt on the extent of venereal dis-
ease, stating that in communities where there is an ade-
quate reporting system, venereal diseases stand next to
measles in extent, and are almost as widespread as tuber-
culosis. As indicative of their cost to the community, he
stated that Massachusetts alone was spending $750,000 a
year for the care of its syphilitic insane.
Marked applause was elicited by the statement that it
has been shown by actual statistics that the present
United States army is the cleanest army of any army in
any war in the history of the world. Whereas in 1916
the annual rate was ninety-one per thousand, the present
rate in the American Expeditionary Forces is twenty per
thousand. The army, finding that, of the women picked
up on the street, 95 per cent have gonori-hea and 53 per
cent have syphilis, has carried on an active campaign
against vice districts.
Every efiort is being made to teach the soldier that he
cannot fight right if he takes his pleasure under a red
lantern. Major Thompson stated that the army's pro-
gram calling for the cooperation of the owners of depart-
ment stores and industrial plants would create a demand
for greater clinical facilities for treatment which the hos-
pitals would be forced to meet. He urged that clinics be
established and that they become trading centers for the
patients as well as treatment centers, since there you get
your best converts who will spread the gospel of a clean
life. He maintains that venereal disease clinics can be
established at slight expense and that, as pay clinics, they
can be made self-supporting. He cited interesting figures
from the Brooklyn Hospital's venereal disease clinic,
showing its growth from 1912 with two thousand treat-
ments to 1917 with three thousand treatments.
In carrying out this program Major Thompson said
they found the doctors the chief obstructionists; the min-
isters were second, and the legislators next. But the
public is being rapidly educated and is demanding ade-
quate facilities for treatment.
Major Thompson's address was followed by a paper by
Miss Ida M. Cannon, chief of the Social Service, Massa-
chusetts General Hospital, on the "Relation of Social
Service to the Successful Treatment of Gonorrhea and
Syphilis in Hospitals and Dispensaries."
Miss Cannon contrasted the traditional attitude of
many hospitals to which persons suffering from alcohol-
ism and venereal disease are not admitted, being victims
of their own sensual indulgence, with the condition in
1916, when a survey showed that, of 126 social service
departments, fifty were giving special attention to syph-
ilitic patients, thirty-nine to gonorrhea in children, and
thirty-one to gonorrhea in adults.
The work of the social service worker in relation to the
treatment of these diseases involves personally meeting
and conferring with the patient regarding treatment,
placing responsibility for payment of fees, rounding up
for examination other members of the family, giving
supeinntendent data on which to base remission of fees,
interpreting the law to the patient as a war measure, and
educating the patient as to the need of the specialist.
;!; :i; * *
Section on Out-Patient Work
September 26, Afternoon
In the absence of Mr. Michael M. Davis, Jr., chairman
of the Section on Out-Patient Work, who was obliged to
return to Boston, Dr. Robert J. Wilson of the New York
City Department of Health, presided.
Because of the omission of the meeting of the Section
on Hospital Administration scheduled for the afternoon,
the privilege of the floor was given to Dr. Adrian Lam-
bert of the Presbyterian Hospital, New York City, who
read a brief paper describing the clinic system of the
Presbyterian Hospital. A pamphlet describing this sys-
tem in detail is now being printed and copies may be had
by addressing a request to the Presbyterian Hospital,
New York City. The recoixl system of this hospital is
an exceedingly efficient one and hospitals generally will
do well to study it.
The meeting of the Out-Patient Section was in the na-
ture of a round-table discussion dealing with present dis-
pensary problems.
Mr. Joseph J. Weber, associate director of the Boston
Dispensary, spoke briefly on the establishment of the
general disease department of the Boston Dispensary. He
stated that the Boston Dispensary coopei'ated with the
Massachusetts State Department of Health, and was
taking prominent part in the national campaign which the
War Department was carrying on for the control of
venereal diseases among the civil population. He sketched
and described its relation to the State Department of
Health, as well as its follow-up system and social service
work.
Dr. A. R. Warner, superintendent of Lakeside Hospital,
Cleveland, Ohio, described the work now being carried
on in the pay clinics of the Lakeside Hospital, dwelling
especially upon the thorough-going effort that is made to
get the out-patient to return for necessary treatment.
Later Dr. Warner was called upon to tell briefly all his
experiences in conducting pay clinics at Lakeside Hos-
pital. The subject, he developed along much the same
lines as in his paper on the Lakeside pay clinic published
in the August issue of The Modern Hospital. Dr. War-
ner emphasized that now many physicians had been called
from the community for war service and this was an
opportune time for starting pay clinics to meet the needs
of the civil population.
Mr. Michael M. Davis, Jr., was reelected chairman of
the Section on Out-Patient Work and Mr. Clarence E.
THE MODERN HOSPITAL
323
Ford, superintendent of the Medical Institutions of the
New York Board of Charities, was reelected secretary.
Section on Social Service
Afternoon, September 26
Mr. John E. Ransom, chairman of the section, being
unable to be present, and Miss Coombs, the secretary,
called away, the meeting- was presided over by Miss Ida
M. Cannon, chief of social service, Massachusetts General
Hospital, and Miss Jarrett was made temporary secre-
tary.
The paper on "A Social Worker at the Admission Desk,"
by Miss Janet Thoi'nton, registrar of Boston Dispensary,
which had been postponed from Tuesday afternoon, was
read. Miss Thornton's paper will be published in The
Modern Hospital.
In discussion, Miss Thornton remarked that all night
clinics are pay clinics; free clinics are needed at night.
She thinks one reason that so many fail to keep appoint-
ments is sometimes rough ti-eatment at the first visit.
In discussing the question of the social worker in rela-
tion to the training school. Miss Wadley, of Bellevue, said
that she reaches probationers for only a fortnight, but
hopes Lhey will remember the training when they leave
such service. Their routine is, one day in office — one day
in records — attend conferences — visit various societies.
In reply to the question whether these probationers retain
this social interest, she replied. "Not very well. Institu-
tional work shuts off such social interest." Massachusetts
General now likes to take nurses in mid-training for their
social service experience. They confer with Miss Lewis
on social aspects of syphilis.
Miss Hoyt, of Rochester Homeopathic Hospital, said:
"We try to get social point of view over to all pupils dur-
ing intermediate stages — try to have them handle or
study type-cases of tuberculosis, syphilis or illegitimacy.
Miss Mary .Antoinette Cannon, of the University of
Pennsylvania Training School, says that pupils get two
full-time months as social workers, and also study social
workers, in morning classes.
Miss Ida M. Cannon, Massachusetts General Hospital,
conducts this work herself, taking fourth-year Harvard
medical students for two months equaling twelve hours'
work for a combination of lecture and case work, which
interests them, and giving history talks, a course of six
lectures, to second-year men. Case workers are some-
times brought into conference with students. Miss Can-
non finds it necessary to make them think of social work
as an actual part of medical course. The introduction of
some special case does much to arouse human interest.
Miss Farmer, Boston City Hosptal, wants to use prac-
tical case work rather than lectures.
Mr. John E. Ransom was reelected chairman and Miss
Farmer secretary of the section. A resolution presented
by Miss Mary A. Cannon, that social workers are greatly
needed, was referred to the .•American Hospital Associa-
tion Committee on Resolutions.
Sections on Administration and Construction
Afternoon, September 27
These two sections held a joint session. The first paper
read was "Two Time-Savers," by Dr. L. H. Burlingham,
supei-intendent of Barnes Hospital, St. Louis.
The next paper was by Mr. William R. Ludlow of New
York, who strongly urged immediate planning of needed
extensions in hospital facilities.
At the close of his paper, Mr. Edward F. Stevens added:
"To plan now means a better opportunity for getting bet-
ter results. If we can plan at leisure and devote more
time to it, as we can now, it goes without saying that we
can get better results."
Mr. Chapman, superintendent of the Mount Sinai
Hospital of Cleveland, Ohio, remarked that hospital con-
struction requires more study and detail work than any
other kind of building; that hospital plans were often laid
without consulting architects, and that in planning hos-
pitals, the advice of architects who have made a special
study of the subject should always be obtained.
Mr. Chapman said that more and more hospitals are
giving attention to the question of making their rooms
more attractive for the patients. "It is remarkable to
note the number of hospitals that now have chintz cur-
tains and tinted walls. I believe that we are beginning to
get away from the thought that it was a broken leg and
his name was John Jones; we are beginning to think a lit-
tle of John Jones as a human being."
In commenting upon the paper of Dr. Burlingham, Mr,
Chapman said, "The number of hospital superintendents
that do not know what is going on in regard to the quan-
tity and cost of supplies they are using is appalling; so
many of them guess. You ask them if they know how
much a certain supply is costing, and they say that they
know it is costing more, but they cannot tell you how
much more They have no system whereby the figures
come up automatically to show them what is being done."
In answer to questions on his system of handling the
institution's laundry. Dr. Burlingham explained: "We try
to get a correct inventory of our linen every six months.
We take the count of the previous inventory and add the
additional amount put into service. Worn-out linen is re-
placed by new, so that unless actually a larger quantity is
being used, there should be no difference in the count.
We find that under this system we do not lose as much
laundry as under the old system, at least according to
our experience within the last four months. However, I
do not credit this fact entirely to the new system. It is
partly due to the fact that we are marking our linen much
more carefully. We also called a conference of our em-
ployees and explained to them that taking an article is
not 'swiping' but just plain stealing." The surplus linen,
Dr. Burlingham said, was kept on shelves in the laundry.
Dr. Neely then read a paper on "War-Time Economies,"
by Dr. T. A. Devan, assistant superintendent Peter Bent
Brigham Hospital.
Mr. Daniel T. Test, superintendent of the Pennsylvania
Hospital, said: "We find in the Pennsylvania Hospital,
that cooperation and team-work mean as gi'eat saving and
efficiency as any other factor. Cooperation on the part
of our employees is one of the most important things.
We call together our doctors, nurses and employees in
separate groups about once every two months, and ex-
plain to them the costs of the materials they are using,
the ways in which they can help economize, the financial
condition of the hospital and the need of economy. Even
the cooperation of the cleaners in using soap has been of
very great benefit. They like this, it pleases the em-
ployees. Don't delegate this to your housekeeper or fore-
man. The help rather like the superintendent to come to
them himself. I might also add that we have found the
24 ,28 gauze tremendously more economical than the
20 24 recommended in Dr. Devan's paper."
Dr. Walker then read Dr. Hersey's paper on "The Hos-
pital Jitern," which dwelt with the problem as applying
to a very large hospital with a well-organized intern ser-
vice and affiliated with a teaching institution, rather than
to the average hospital which is to be found throughout the
country.
324
THE MODERN HOSPITAL
Dr. Hurd remarked: "At the present time we are
forced to face new conditions and forced to do differently
than we shall be able to do after the war. I have been
of the opinion for some time that senior medical students
could fret much more out of their final year by active work
in the hospitals. One way in which we can help them to
do this is by making it possible for them to spend
less time in writing histories and other records. In
some places they have used the dictaphone to very good
advantage. In other places stenographic help has been
provided so that they need merely dictate the history and
other records and thus save a great deal of their time.
Now that interns are so very difficult for many hospitals
to obtain, this seems particularly advisable. In hospitals
where it is felt that stenographic aid is too expensive, it
has been found possible to secure volunteer workers of
considerable intelligence and education, who are willing to
do this work without charge for the hospital."
Dr. Neely of the Brooklyn Hospital in commenting upon
the possibilities of crowding a more intensive service into
the intern year, said that when his interns had been
asked if they wished to have their courses on gynecology
and obstetrics eliminated, they very sti-ongly protested
upon the ground that they wished a well-rounded-out
training, which they would not get when they were drafted
into the army.
♦ * * *
Section on Dietetics
This section met in conjunction with the American
Dietetic .Association, and a full report of the meeting will
appeiir next month.
List of Members, Delegates and Guests Registered at the
American Hospital Association Meeting at Atlantic City
The asterisk opposite a name denotes a new member.
Adelaide. Sister Mary Wheeling Hospital, Wheelins. W. Va.
Agape. Sister Mary St. Joseph's Hospital. Lancaster. Pa.
Ahern. D. C Supt., Hahnemann Hospital. Chicaco, 111.
Ahrens. Eleanor Supt.. Lake View Hospital, ChicaKO, 111.
Aikens, Charlotte A Editor of Trained Nurse & Hospital Review,
Detroit. Mich.
Alexander. Dr. James R.Presbyterian Hospital, Charlotte, N. C.
Allen. Miss Bertha W Lowell General Hospital. Lowell, Mass.
Altschul. David S 71 Park Place. New York City
Ancker. Arthur B President of the American Hospital Asso-
ciation, St. Paul. Minn.
Anderson, Emma A N. E. Baptist Hospital. Boston, Mass.
•Anderson. Isabella Craig. Acting Supt. of Nurses. University of Vir-
ginia, Charlottesville, Va.
Andrews. Miss Fannie
Vaughan Mission Hospital, Asheville. N. C.
Appel. Katherine Howard Hospital. Philadelphia, Pa.
Armstrong, D. B Framingham, Mass.
Ashee. Alice M New Orleans, La.
Ayer. Miss Eugenia D... General Hospital, Elizabeth, N. J.
Bacon. Asa S Presbyterian Hospital. Chicago, 111.
Bailey. George. Jr Cooper Hospital. Camden. N. J.
Ball. Dr. O. F Modern Hospital. Chicago
Bancroft. Mrs. Joseph. .. .Homeopathic Hospital, Wilmington Del
Bannard, Mrs. W. N Delaware Hospital, Wilmington. Del.
Battle. S. W., Dr Med. Dir.. Clarence Barker Memorial Hos-
pital. Asheville, N. C.
•Barr. Jos. W Oil City Hospital, Oil Citv, Pa
Barnaby, Marietta S Hey wood Memorial Hospital, Gardner, Mass
Barnes. Sydney J Orange Memorial Hospital, East Orange,
N. .1.
Bartine. Oliver H New York City
Bates. F. O Roper Hospital. Charleston. S. C.
Bauernfeind, J Evangelical Deaconess Hospital, Chicago III
Beers, Mollie Cambria Hospital, .lohnstown. Pa ' '
Behrens. P. W Toledo Hospital. Toledo, O.
Berchmans. Sister M St. Joseph's Hospital. Parkersburg. W Va
•Bescherer. Francis H Woman's Hospital, Cleveland, O.
Bernstein. J Greenville Hospital, Jersey City.
Betts. Adeliza A N. E. Deaconess Hospital, Boston Mass
Bewley. L. H Atlantic City. N. J.
Bigger, James H Western Pennsylvania Hospital, Pittsburgh
Pa.
•Binkley, Miss Artie M Supt., Charity Hospital, Morristown Pa
Bishop. Howard E Robert Packer Hospital, Sayre, Pa.
•Bitzer. Newton E St. Joseph's Hospital. Lanca.ster Pa
Blankenship. Mrs. R. V..Rex Hospital. Raleigh. N. C
Bloxhiim. Nellie L Kimball Hospital. Putman. Conn
Borden. Richard P Union Hospital, Fall River, Mass
Boteler, M. E Chiblren's Hospital, Bainbridge. Ga
Boyce. Sister M. Isidore. .Pittsburgh Hospital. Pittsburgh Pa
•Bracken. Dr. H. W State Board of Health. St. Paul. Minn.
Breitinger. W. M Lancaster General Hospital. Lancaster. ' Pa
Briggs. Gertrude A Chicago. III.
Brinton, Bessie Lakeside Hospital, Cleveland. O.
•Britton, Harry A., M. D. .Minneapolis City Hospital. Minneapolis,
Minn.
Brobson. Miss Anna K Philadelphia, Pa.
Brodrick, R. G San Francisco Hospital. San Francisco, Cal.
Brogden, Miss Margaret S.Johns Hopkins Hospital. Baltimore. Md.
Brovrae, Elsie M Douglass Hospital, Phila '.elphia.
Browne, Mrs. D. I Tulsa. Okla.
Brush. Edward N Sheppard & Enoch Pratt Hospital, Balti-
more. Md.
Bryan, Edith Cambria Hospital, Johnstown, Pa.
Byrne. Jos.. M. D Fordham University, New York City
Bunn, F. S Y'oungstown. O.
Burgan, John State Hopsital. Scranton, Pa.
Burlingham. Louis H Barnes Hospital. St. Louis. Mo.
Burley. Nelly R Richmond Hill. L. I.
Burt. Bertha Hart Hart Private Hospital, Roxbury, Mass.
•Butler. Alice. M. D Woman's Hospital. Cleveland. O.
Butterfield. Caroline L... Martins Ferry Hospital. Martins Ferry, O.
Caddy, Eva Fox Memorial Hospital. Oneonta, N. Y.
Cain, G. D., Jr Chicago
Cannon. Ida M Massachusetts General Hospital. Boston, Mass.
Cannon, Mary Antoinette.University Hospital, Philadelphia
Chapin. M. K The Model-n Hospital. Chicago, III.
Castlelaw, Rush E Wesley Hospital, Kansas City
Catton, Miss Jessie E St. Luke's Hospital, St. Paul, Minn.
Chapman, F. E Mt. Sinai Hospital, Cleveland. O.
Chappell, Frances St. Luke's Hospital. St. Louis, Mo.
Christianson, A. Jeanette.Northwestern Hospital. Minneapolis, Minn.
Clark, J. Clement, Dr Springfield Hospital, Sykesville. Md.
Clark, P. O Ohio Valley General Hospital, Wheeling,
W. Va.
•Clark. W. Julian Columbia Hospital, Columbia, S. C.
Clayton. Lillian S Supt.. Philadelphia General Hospital, Phila-
delphia, Pa.
•Cleave. K. Frances Samaritan Hospital, Philadelphia, Pa.
Cleveland, Edw. H. Rev. .Supt.. Hospital for Consumptives, Inwood-
on-Hudson. N. Y.
Coleman. Louise M House of the Good Samaritan. Boston, Mass.
Cole, C. G State Presbyterian Hospital. New Orleans,
Combs. Mary H 40.i Lexington Ave.. New Y'ork City
Conley. Dr. Walter H Metropolitan Hospital. Blackwell's Island,
New York City
Condon, W. M Harrisburg Hospital, Harrisburg, Pa.
Cope. John Purdy General Hospital, East Stroudsburg, Pa.
•Cowan. Margaret B Presque Isle. Me.
Cowles. Annette B Maternity Hospital. St. Louis, Mo.
•Cock. Dora E Roanoke Rapids Hospital, Roanoke Rapids,
N. C.
Cooper. Lenna Sanitarium. Battle Creek. Mich.
Cratty. John M Presbyterian Hospital. Philadelphia
Crew. E. R Miami Valley Hospital. Dayton. O.
Crieihowski. W. P Wawatosa. Wis.
Gumming, Margaret M. ..Christian H. Buhl Hospital. Sharon. Pa.
Cutler. Helen L, 42H E. 26th St.. New York City
Davis. Nellie Erie County Hospital. Buffalo. N. Y.
Davis. Michael M., Jr.... Boston Dispensary. Boston, Mass.
Davison, Nina P Kings' Daughters Hospital, Staunton. "Va.
Davidson. S. G Samaritan Hospital. Philadelphia, Pa.
Deaver, Mary F Christ Hospital. Cincinnati. O.
Denton. Emily, Miss General Hospital, Saranac Lake. N. Y.
•DeGroat, Dr. H. K Department Hospital and Dispensary, Buf-
falo. N. Y.
•DeWitt, Mrs. W. E Saginaw General Hospital, Saginaw, West
Side. Mich.
Diehl. Charles F Flower Hospital. New York City.
•Dolorosa, Sister Mary St. Catherine's Hospital. Brooklyn. N. Y.
Dougherty. Fannie A Cottage State Hospital. Philadelphia. Pa.
Dowling. D. G Hahnemann Hospital. New York Citv
Duffy. Rev. E. P St. Vincent Charity Hospital. Cleveland, O.
Dolan. Thomas E Receiving Hospital. Detroit. Mich.
Dwyer. John R Omaha. Neb.
Durnin. Mary Danbury, Conn.
Dreyfoos. Dr. Max Jewish Hospital, Cincinnati. O.
Daniel, Mrs. Gertrude
Ford Domestic Science Dept., Brookline. Mass.
Eager. Mary L Rush Hospital. Philadelphia. Pa.
Ebbert. L. Hilda Springfield Lake Sanatorium. Akron. O.
•Ebendick, Mrs. Julia City Hospital. Lockport. N. Y.
Eckman. Rena S Columbia University. New York City
•Eggert. Carrie L Woman's Hospital. Detroit, Mich.
•Eulalia. Sister M St. Joseph's Hospital. Baltimore, Md.
Emmott. Susan E St. Luke's Hospital. New Bedford. Mass.
Essig. Anna K Coatesville Hospital. Coatesville. Pa.
Etheldreda. Sister M Mercy Hospital. Pittsburgh. Pa.
•Eugenia, Sister M Mary Immaculate Hospital. Jamaica. L. I.
English. Samuel B N. J. State Sanatorium. Glen Garden. N. J.
Fay. John E Ellis Hospital. Schenectady, N. Y.
Fairley. Grace Alexander Hospital, Montreal. Can.
Farmer. Miss Gerti-ude.L. Director City Hospital, Boston, Mass.
Ferguson. Irene M Supt.. Santa Filomena Sanatorium. San
Francisco. Cal.
Fesler, Paul H Supt., University Hospital. Oklahoma City,
Okla.
Franklin. J. B Baptist Sanitarium, Dallas. Tex.
'French. Nellie S Supt.. St. Luke's Hospital. Bluefleld, W. Va.
Friedman, Nina Dale Supt.. Grant Hospital of Chicago, Chicago,
III.
Fonkalsrud. A. O Supt.. Norwegian Hospital. Brooklyn. N. Y.
Ford, Clarence E The Capitol. State Board of Charities. Al-
bany. N. Y.
Ford, .Mrs. A. L Children's Hospital, Pittsburgh. Pa.
Fowler, Benj. M Supt., Vassar Bros. Hospital, Poughkeepsie,
N. Y.
Fulgentia, Sister M Supt.. St. Francis' Hospital. Trenton. N. J.
Fleet, J. W Pottsville, Pa.
Flaws. Eliz. G Supt.. Wellesley Hospital. Toronto, Can.
THE MODERN HOSPITAL
325
Gailey. Ida M.. R. N Supt.. Memorial Hospital, Johnstown, Pa.
GallaEher. Jas. J Supt.. City Hospital. Jersey City, N. J.
Garrabrandt. Dr. C 19 N. Penn. Ave., Atlantic City, N. J.
Gallery, Elizabeth A Supt., Reading: Hospital, Reading. Pa.
Gartshore. W. M Trustee. Victoria Hospital. London. Canada
Gage, Harriet Director of Social Service. Milwaukee Chil-
dren's Hospital. Milwaukee. Wis.
Geffen. Joseph Mt. Sinai Hospital, Philadelphia. Pa.
Genevieve. Sister M Supt.. St. Elizabeth's Hospital. Yountrstown.
Georgiana, Sister M Supt., St. Aenes Hospital. Philadelphia. Pa.
Geraldine. Sister M Asst. Supt.. St. Elizabeth's Hospital.
Younjrstown. O.
Gibson. Mrs. Gertrude W.Supt.. Prospect Heights Hospital. Brooklyn,
N. Y.
Geraghty. W. M Dietian. New Haven Hospital. New Haven.
Conn.
Gwyer. Dr. Frederick Supt.. Lincoln Hospital. New York
Gill. Chas, A Supt.. Germantown Hospital, Germantown.
Philadelphia. Pa.
Gilmore. E. J Supt.. Wesley Memorial Hospital, Chicago.
III.
•Goodwin. Chas. W.. M. D.Supt.. Staten Island Hospital. Tomkinsville.
S. I.. N. Y.
•Good, N. W Supt.. Protestant Hospital. Columbus. O.
Goodwin. H. C Supt.. Albany Hospital. Albany. N. Y.
Gaggs. Alice Muriel. J. N.Norton Memorial Infirmary. Louisville. Ky.
Graham. W. T.. M. D Supt.. University Hospital. Iowa City. Iowa
Green. Frederick B General Secretary. United Hospital Fund of
N. Y.. New York
Griffin, Rev. Maurice F. ..Trustee. St. Elizabeth's Hospital, Youngs-
town. O.
Graves. Lulu Pres.. American Dietetic Association. 58 E.
Washington St., Chicago. 111.
Grimshaw. Chas. B Supt.. Roosevelt Hospital. New York City
Greener, Elizabeth A Supt. of Nurses, Mt. Sinai Hospital, New-
York
Guenther, Leopoldine Supervisor of Nurses, Philadelphia Hospital
for Contagious Diseases. Philadelphia. Pa.
Gutwald. Kathryn R Supt., Mercy Hospital, Columbus. O.
Happel, Mary E 57 Leonard St.. New York City
Haworth. Jno St. John's Riverside Hospital. Yonkers. N. Y.
Haasis. Mrs. Bessie A 156 5th Ave.. New York City
Hamel. Mrs. H Supt.. Memorial Hospital. Mt. Pleasant, Pa.
Higbee. Eliz. A Hackensack Hospital. Hackensack. N. J.
•Hornsby. Dr. Charles ... .Supt.. St. John's Rivei-side Hospital. Yonk-
ers. N. Y.
•Haddon. George Sec. Vancouver General Hospital. Vancou-
ver. B. C.
Hamer. Laura M Supt., Mercy Hospital. Altoona, Pa.
Hartry. Miss Harriet .... St. Barnabas Hospital. Minneapolis. Minn.
Hall. Nathan P Supt.. Franklin Hospital. Philadelphia. Pa.
Hamilton. Dr. Stewart. . .Supt.. Harper Hospital. Detroit. Mich.
Hamilton, Mrs. Jos. B Supt.. Somerset Hospital. Somerville. N. J.
Happersett. C. R. N Supt.. Lock Haven Hospital. Lock Haven. Pa.
Haworth. E. P Supt.. William Maternitv Sanatorium. Mgr.
Grace Hospital. Kansas City. Mo.
•Haws. Mary E Supt.. Hahnemann Hospital. Scranton. Pa.
Hayman. Jean G Supt.. Bushwick Hospital. Brooklyn. N. Y.
Hayden. Mrs. Sarah Supt.. Augusta General Hospital. Augusta.
Me.
Hayes. Mary A Asst. Supt.. University of Pennsylvania Hos-
pital. Philadelphia. Pa.
Hays. Dr. M. J Supt.. Kane Summit Hospital, Kane, Pa.
Haywood. A. K.. M. D...Supt.. Montreal General Hospital. Montreal.
Quebec
Hedden. Henry Supt.. General Public Hospital. St. John. N. B.
•Hancker. Wm. H.. M. D.Med. Supt., Delaware State Hospital. Farn-
hurst. Del.
Henderson. Miss B. M Supt.. Children's Memorial Hospital.Chicago.
111.
Herman. Sister Mary St. Joseph's Hospital. Lancaster. Pa.
Herrmann. Mary R Supt.. Perth Amboy City Hospital. Perth
Amboy. N. J.
Hevessy. Berthold Supt.. Jewish Hospital. Philadelphia. Pa.
Heimer. W. H., M. D.. .Supt.. Park Place Hospital. Pawtucket. R. I.
Hewes. Albert, S. L Supt. and Treas.. West Philadelphia General
Homeopathic Hospital. Philadelphia. Pa.
Highsmith, D. J Owner and Surgeon. Highsmith Hospital.
Fayetteville. N. C.
Hill. Caroline, R. N Supt., Mary McClellan Hospital, Cambridge.
N. Y.
Hilda. Sister M New Castle Hospital. New Castle. Pa.
Hildreth. C. B Supt.. St. Luke's Hospital. Cleveland. O.
Hilker. F. C Supt.. St. John's Riverside Hospital. Yonk-
ers. N. Y.
Hill. Miss M Supt.. West Side Hospital. Scranton. Pa.
Hill. C. D.. M. D Supt.. Watts Hospital. West Durham. N. C.
Hill. Dr. H. Philip Supt.. Robt. B. Green Memorial Hospital.
San Antonio. Tex.
Hofseth. Miss .Astrid
R. N Supt. of Nurses and Asst. Supt. Methodist
Hospital. Omaha. Neb.
Holt. E. E Maine Eye and Ear Hospital. Portland. Me.
Hortense. Sister M St. Elizabeth's Hospital. Youngstown. O.
Hornbeak. S. H Physicians' and Surgeons' Hospital. Corsi-
cana. Tex.
Howard, J. R.. Jr New York Orthopedic Hospital. N. Y. City
Howland. Joseph B Massachusetts General Hospital. Boston.
Mass.
Hunt, A. C State Department of Health. Trenton. N. J.
Hunt. Nellie E Supt.. Ellwood City Hospital. Ellwood City,
Pa.
Hurd. Henry M Supt., John Hopkins Hospital, Baltimore. Md.
Huth, F. C, M. D Surgeon of Cambridge Hospital, Cam-
bridge, O.
Innocent, Sr. M Mercy Hospital, Pittsburgh, Pa.
Ivory. Margaret A Windber Hospital. Windber. Pa.
Jamieson. May A Supt.. Grant Hospital. Columbus. O.
Johnson. T. M Frederick. Md.
Johnson, Jane Bradford Hospital. Bradford. Pa.
Jennings. Miss V. M St. Luke's Hospital. San Francisco. Cal.
Johanna, Mother M Danville. N. Y.
Jackson, Mary C Supt.. W. C. Graham Hospital, Keokuk, Iowa
•Jarrett, Miss Mary Psychopathic Hospital, Boston. Mass.
Jeffrey. Annie C St. Christophers Hospital. Philadelphia. Pa.
James. Sr. Mary St. Joseph's Hospital. Lancaster. Pa.
Johnston. M. L Rochester Homeopathic Hospital. Rochester,
N. Y.
Jones, Frank R Willard Parker Hospital. New York City
Jones. William M Bridgeport Hospital. Bridgeport. Conn.
Jones. Mary Moore Supt.. Children's Episcopal Hospital Cin-
cinnati, O.
Josephi, Hannah L Head Worker, N. Y. Hospital. New York City
•Judge. James P St. Peter's Hospital. Brooklyn. N. Y.
•Kandel, Phoebe Miller Supt., Springfield City Hospital, Spring-
field. O.
Karp, T. J Mgr., Colonial Hospital, Rochester. Minn.
•Karrakis. Joseph Supt.. Beth Israel Hospital. Newark. N. J.
Kelley. E. A.. R. N Supt.. Highsmith Hospital. Fayetteville. N. C.
Keller. Lydia H.. R. N...Sec. and Treas., Minnesota State Hospital,
St. Paul, Minn.
Keith, Mary L Rochester General Hospital. Rochester. N. Y.
•Kent. E. M. Violet Overlook Hospital. Summit. N. J.
Kienle. Rev. G. A Supt.. General Hospital. Mansfield. O.
Knight, Mrs. S. H Supt.. M. E. Deaconess' Hospital and Home.
Minneapolis. Minn.
Korndorfer. A Med. Dir.. Children's Homeopathic Hospital.
Philadelphia. Pa.
Knapp. Macie N Overlook Hospital, Summit, N. J.
Krusen. Dr. E. A Riverview Private Hospital. Norristown. Pa.
Kurtz. Ida M Supt. Northwestern General Hospital. Phila-
delphia. Pa.
Laughlin. Anna E Supt.. Bryn Mawr Hospital. Bryn Mawr. Pa.
Lent, Mary E U. S. P. H. S., Washington, D. C.
Lockwood, Miss Mary L.. 602 West St.. Wilmington. Del.
Ludovica. Sister M Danville. N. Y.
Lynch. Albert Fairbury. Neb.
•Landh. Miss S Good Samaritan Hospital. Sandusky. O.
Landis. Maude New Haven Hospital. New Haven. Conn.
Langrill. Dr. W. F Hamilton City Hospital. Hamilton. Can.
•Lawler. Dr. J. M Supt.. Allegheny General Hospital. Pitts-
burgh. Pa.
Lawson. M. A City Hospital. Akron. O.
Lake. Amzi Supt.. Masonic Home. Burlington. N. J.
Le Febure. Theodora Mt. Vernon Hospital. Mt. Vernon. N. Y.
Leonard. I. E Supt.. Leonard's Sanitarium, Atlantic City,
N. J.
•Leppert. Louisa M Theda Clark Hospital. Neenah. Wis.
Lewis, Edwin R Hahnemann Hospital. Rochester. N. Y.
Littlefield. Julia A Supt.. Homeopathic Hospital. Albany. N. Y.
Locke, Dr. H. L. F Supt., Hartford Isolation Hospital. Ha:*ford,
Conn.
Loder. Cornelius S 30 Church St., New York.
Loveland, F. A Corry. Pa.
Ludekens. F. Virginia Atlantic City Hospital. Atlantic City. N. J.
Lurkins. Frances L Supt.. Laura Franklin Free Hospital for
Children. New York.
Lyons. Barrow B Delaware Hospital. Wilmington. Del.
MacEachern. Malcolm. T.
M. D General Supt., Vancouver General Hospital,
Vancouver. B. C.
MacGarry. Mary C Supt.. Charter Oak Hospital. Hartford. Conn.
•MacKay. Alex. M. D Inspector of Hospitals. Province of Ontario.
Toronto. Ont.
MacLeod. Dr. Norman M.Supt.. Newport Hospital. Newport. R. I.
McNichols. C. E Supt.. St. Peter's Hospital. Charlotte. N. C.
McMillan. Dr. W. A Supt., McMillan Hospital, Charleston, W. Va.
McNichols, Miss E. H Supt., Presbyterian Hospital, Charlotte, N. C.
Manley, Florence H., R.
N Supt., Niagara Falls Memorial Hospital,
Niagara Falls, N. Y.
Marcella, Sister M Sister of Charity, Directress of Nui-ses, Pitts-
burgh Hospital, Pittsburgh, Pa.
•Mary Dolorosa, Sister St. Catherine's Hospital, Brooklyn, N. Y.
•Mary Eugenia. Sister ... .Mary Immaculate Hospital Association.
Matthews. Elmer E Supt.. Wilkes-Barre City Hospital, Wilkes-
Barre. Pa.
Matthews. Frances C Supt.. New Samaritan Hospital, Sioux City,
la.
Mauss. Bessie W Supt., General Hospital, Wellsville, N. Y.
Maxwell, Anna C Presbyterian Hospital. New York City.
McArthur. Miss E. J Supt.. General Hospital. Stratford. Ont.
•McCreight. M. Emily Supt.. Arnot Ogden Hospital. Elmira. N. Y.
McElderry, Grace D.. R.
N Supt.. Hackley Hospital. Muskegon. Mich.
McEwen. Rachel Supt.. Maiden Hospital. Murry Hill Road,
Maiden. Mass.
McLaren. Margaret Supt.. Warren General Hospital. Warren. Pa.
McKee. Gertrude Supt.. Milwaukee Children's Hospital. Mil-
waukee. Wis.
McLeod. Josephine Supt.. Johnston-Willis Hospital. Richmond,
Va.
•Meloy. Dr. Carl R Grace Hospital. Detroit. Mich.
Maurgold. Louis Wauwatosa. Wis.
MacNichols. Emma V Charlotte. N. C.
Mann, D. B.. Miss Supt.. Williamsport Hospital. Williamsport,
Pa.
McMahon. Mary St. Joseph's Hospital. Omaha. Neb.
Marshall. George Morley.
Dr Philadelphia. Pa.
Miner. G. S.. Dr Trustee Receiving Hospital. Detroit. Mich.
Morrow. .loseph R.. Mrs. .Oradell. N. Y.
Matrone. Sister M St. Joseph's Hospital. Baltimore. Md
Markey. Eliz. G.. Mrs.... St. Joseph's Hospital. Chicago, 111.
Mathison. Wm. R Briardale Hospital, Toronto, Canada.
Metcalfe, Rachel A Supt., Central Maine General Hospital, Lew-
iston. Me.
Middleton. Miss Mary A.. Supt.. Methodist Episcopal Hospital. Phila-
delphia. Pa.
Minahan. Elizabeth Supt.. Wilhenford Hospital, Augusta, Ga.
326
THE MODERN HOSPITAL
•Mindte, Anna C Supt. of Nurses, Memorial Hospital, New
York City. ^ ^^ ,
Miller, Elizabeth Supt.. Dover General Hospital. Dover, N. J.
Miller, Elizabeth F University of Pennsylvania, Philadelphia, fa.
Millman, Miss Elizabeth .i , ^
M Supt., Orange Memorial Hospital, Orange,
N. J.
•Morley, Miss Rye Supt., New York Nursery & Children s Hos-
pital, New York City.
Moyer, Katharine A Supt., Pottstown Hospital, Pottstown, Pa.
•Moody, Earle F Pres., Moody Hospital, Dothan, Ala.
Moore, Lucy M Supt., Knickerbocker Hospital, New lork
City.
Moore, Frances W Supt., Sibley Hospital, Washington, D. C.
Moore, Helen de Spelder..Supt., W. A. Foote Memorial Hospital, Jack-
son, Mich.
Morris, Anna L Supt., White Haven Sanatorium, White
Haven, Pa.
Morris, C. C Supt., Baptist Hospital, St. Louis, Mo.
Morrow Joseph R Supt., Isolation Hospital, Bergen Co., Ora-
dell, N. J.
Morgan, Dr. Esther Supt.. Dixie Hospital, Hampton. Va.
Moss, H. J., M. D Supt., Hebrew Hospital, Baltimore. Md.
Mossell. M. S Supt.. Douglass Hospital, Philadelphia. Pa.
Mothershead. Pearl A Supt., Ottumwa Hospital. Ottumwa, Iowa.
Mueller, Mrs. Margaret . .Supt., Greenville Hospital, Jersey City, N. J.
•Munger. C. W Supt.. Columbia Hospital, Milwaukee, Wis.
Monroe, J. P Charlotte Sanatorium, Charlotte, N. C.
Murphy, Addie L Supt., Maternity & Children's Hospital,
Toledo, O.
•Murray, E. W Med. Dir.. Babies' Hospital, Newark, N. J.
Musgrave. Dr. W. E Univ. of California Hospital, San Francisco,
Cal.
Myers. J. O Med. Dir., Tranquil Park Sanitarium, Char-
lotte, N. C.
Nagle, A. F., Jr Modern Hospital. New York City.
Narr, Fred C, Dr Pathologist Passavant Hospital, Pittsbuitth,
Pa.
Nassaud, Sarah Bethel Sisterhood Supt., .57 E. 86th St., New
York City.
Nealey, Dr. W. G Supt, Brooklyn Hospital, Brooklyn, N. Y.
Nevins, Georgei Dir. of Nurses, Potomac Division, Washing-
ton, D. C.
Newman, W. M Supt., Sewickley Valley Hospital, Sewickley,
Pa.
•Neumer, Howard E St. Luke's Hospital, Bethlehem. Pa.
Norris, John U Acting Supt., Presbyterian Hospital, New
York City.
Oberg. C. I Supt.. Sherman Hospital. Elgin, 111.
O'Hara, Margaret G Directress, Dermady Cottage Sanatorium.
Morton. Pa.
Olsen, E. C Supt.. Englewood Hospital, Chicago. 111.
Owen, Elizabeth M Highsmith Hospital, Favetteville, N. C.
Page. H. F Med. Supt.. Lankman Hospital. Philadelphia.
Pa.
Parker. H. E Supt.. Kensington Hospital. Philadelphia. Pa.
Parnall, 0. G Dir. University Hospital, Ann .f^rbor, Mich.
Patrick, T. A Lincoln Co. Hospital. Fayetteville. Tenn.
•Perry, Miss Charlotte M..Supt.. Faxton Hospital. Utica, N. Y.
Peters, J. M Supt.. K. I. Hospital. Providence. R. I.
Phillips, G. E Supt., Herman Kiefer Hospital, Detroit, Mich.
Pine. Emily Supt., R. S. Frost Hospital, Chelsea, Mass.
Pinkerton, Eliz., Miss Supt., Nyack Hospital, Nyack, N. Y.
Pitcher, C. S Kings Park San.. Kings Park, N. Y.
Pollock, Helen M Instructor, Grace Hospital, Detroit, Mich.
Powell, L. M Acting Supt., University Hospital. Minneap-
olis, Minn.
Pond, E. L Brooklyn Hospital, Brooklyn, N. Y.
•Potter. Ellen 0 Cottage Hospital, Philadelphia, Pa.
Potter, E. C Med. Dir.. Medical College of Pennsylvania,
Philadelphia, Pa.
Potts, F. J Supt., Hospital for Sick Children, Toronto,
Can.
Putts, Mary J Supt., Kings' Daughters' Hospital, Temple,
Tex.
Purvis, Joseph Supt., West Suburban Hospital, Oak Park,
111.
Price, Dr. G. M Union San., New York City.
Qualioni, Friedman Mount Sinai Hospital, Cleveland. Ohio.
Ranson, Mildred L ^^ Leonard St., New York City.
Read, C. O Pres. Board of Trustees, Pawtucket Memorial
Hospital, Pawtucket, R. I.
Reardon, E. A Supt., Ohio Valley Hospital. McKees Rocks
Pa.
Redwine, Miss E. M Supt., Meriweather Hospital, Asheville, N C
Richardson, Dr. Katherinc
B Children's Mercy Hospital. Kansas City, Mo
Ricketts, H. E Supt., Essex County Hospital. Belleville. N J
•Rita, Sister Mary Supt. Mercy Hospital, Chicago, III
Robins, Charles B Richmond, Va.
Rose, Mrs. Summer A. .. .Homeopathic Hospital, New York.
Rock ins. Sister M St Joseph's Hospital, Baltimore, Md
RobeHs, Catherine E .lohnstown. Pa.
Rosealinde, O. S. D St. Catherine's Hospital. Brooklyn, N. Y
Romana, Sister M Supt, St Joseph's Hospital. Kansas City Mo
Rogers, Margaret Supt, Jewish Hospital, St. I.ouis, Mo.
•Rogers, Margaret A Supt.. Children's Free Hospital, Detroit.
Mich.
Roche, Frances E Asst Sunt., Litchfield County Hospital Win-
stcd. Conn.
Robertson, Marie Deaconess Hospital, Buffalo, N. Y.
Robertson, Donald M Supt.. Protestant Hospital, Ottawa Can
Rothrock, Anna E Supt., Union Hospital, Fall River, Mass
Riley, Ella S St. Frances Hospital, San Francisco, Cal
Rushmore, Stephen, Dr... Carney Hospital. Boston, Mass.
Russell, C. M Massillon Hospital. Massillon. Ohio
•Russell, May M Jewish Hospital, Cincinnati, O.
Schmabel. Eliz. H Division of American Red Cross, Philadel-
phia, Pa.
Shancher, R. H St. John's Hospital. Yonkers. N. Y.
Singer. Douglass H Dept of Public Welfare. Kankakee. 111.
•Shaeffer, Susan V Supt., Easton Hospital, Easton, Pa.
•Saffeir, Rosa A Supt., The Jamaica Hospital, New York City.
de Sales, Sister M St. Joseph's Hospital.
Salome. Sister M St Francis Hospital. Pittsburgh. Pa.
•Sauer, G. F Supt.. Lennox Hill Hospital. New York City.
Schill, Anna M Supt., Hurley Hospital, Flint Mich.
•Schneider, Miss P J. C. Blair Memorial Hospital, Huntington,
Pa.
Schulz. F. M Wauwatosa, Wis.
Schwab. Barbara Jewish Hospital, Philadelphia, Pa.
Schwab. David Supt, Barnert Memorial Hospital, Paterson,
N. J.
Scott Kathleen Supt.. Sparrow Hospital. Lansing. Mich.
Seabrook. Alice Supt, Woman's Hospital, Philadelphia, Pa.
Seem. Dr. R. P Johns Hopkins Hospital. Baltimore. Md.
Selby, Nelle M Memorial Hospital, Pawtucket Hospital, Paw-
tucket, R. I.
•Seymour, Adelene Supt., Samaritan Hospital. Detroit, Mich.
Sexton, L. A Supt., Hartford Hospital, Hartford, Conn.
Shaw. J. M Supt.. Hospital for Women and Children,
Newark, N. J.
Smith, A. W Supt. Garfield Hospital, Washington, D. C.
Smith. J. N Supt.. Muhlenberg Hospital, Plainfield, N. J.
Smith, Nina A Lancaster General Hospital. Lancaster, Pa.
Smylie. Margaret S Supt, St. Timothy's Hospital, Philadelphia,
Pa.
Stanislaus. Sister Mary.. St. Mary's Hospital, Clarksburg, W. Va.
Steinmetz, Rose Supt.. Children's Hospital, Akron, O.
Stevens, E. F Boston. Mass.
Stewart, Annabel L Women's Southern Homeopathic Hospital of
Philadelphia, Philadelphia, Pa.
Stokes, L. W Supt., Women's Southern Homeopathic Hos-
pital of Philadelphia. Philadelphia, Pa.
Stone, Mary Supt., Hackensack Hospital, Hackensack, N, J.
Strasser, C. E Supt., Jewish Hospital. Brooklyn, N. Y.
Surbray, Mary E Supt., Warren Hospital. Warren, O.
•Smith, Emma Margaret. .Corning Hospital. Corning. N. Y.
Stewart. Chas. E Asst. Supt. Battle Creek Sanitarium. Battle
Creek. Mich.
Stafford. S. W Charity Hospital. New Orleans. La.
Smith. Marion Supt, University Hospital, Philadelphia, Pa.
Schafer, Esther E Acting Supt.. Chester County Hospital, W.
Chester, Pa.
Smith. Theresa Marie Supt. Stormont Hospital, Topeka, Kan.
Shardon. Wm.. Dr Ml E. 86th St.. New York City.
Summer, Mrs. A. W President. Women's Southern Homeopathic
Hospital, Philadelphia, Pa.
Tall. Anthony Supt.. Buffalo Homeopathic Hospital, Buffalo,
N. Y.
Taggart, Thomas D Atlantic City, N. J.
Talbot C. E Supt., Newark City Hospital, Newark, N. J.
Tebbets. Marion A Minneapolis, Minn.
Test. D. D Pennsylvania Hospital. Philadelphia. Pa.
Templeton. Nelle I Supt., Salem City Hospital, Salem, O.
Turpin. Mary B Supt, Eye and Ear Hospital. Pittsburgh, Pa.
♦Thompson, Florence M . . . Supt, St. Luke's Hospital. Davenport Iowa.
Thatcher, Alice Supt., Christ Hospital, Cincinnati, O.
Tipping, A. B New Orleans, La.
♦Toll. Henry W Navy Building. Washington. D. C.
Tinsley. Esther J Supt.. Pittston Hospital. Pittston. Pa.
Turner, Alida Supt.. Homeopathic Hospital, Wilmington,
Del.
Tuley. H. E Supt.. Louisville City Hospital. Louisville, Ky.
Thornton. Janet Boston Dispensary, Boston, Mass.
Toland, M. C Babies' Hospital, Dispensary. Philadelphia,
Pa.
Van Vort, Rose Z Supt.. Stuart Circle Hospital, Richmond, Va.
Viehdorfer, Alma M Supt., Allentown Hospital, Allentown. Pa.
•Vidt John C Newark City Hospital, Newark. N. J.
Van Slyke. Elizabeth, Dr. Women's Hospital. New York City.
Vaughan. Mrs. E. E Chicago Union Hospital. Chicago. 111.
Virginia. Sister M Repre. Sister M. Elenore. Marshfield, Wis.
Wadley. Mary E Belle\-ue Hospital. New York City.
Walker, Eugene, Dr Asst Supt.. Massachusetts Charity Eye and
Ear Hospital, Boston, Mass.
Warner. A. R Lakeside Hospital, Cleveland, O.
Washburne, Ida Supt.. Eastern Maine General Hospital, Ban-
gor. Me.
•Watson, William Essex County Hospital, Belleville, N. J.
Watson, Elizabeth West Philadelphia Hospital for Women,
Philadelphia. Pa.
Weber, Gertrude T Olney Sanitarium, Olney, 111.
Weber, Joseph The Modern Hospital, Boston, Mass.
Weber, F Supt.. Evangelical Deaconess Hospital, Chi-
cago, 111.
Webster. H. E Supt.. Royal Victoria Hospital, Montreal.
Can.
•West George. M. D West Ellis Hospital, Chattanooga, Tenn.
Weiss, Dr. E. A Mercy Hospital, Pittsburgh, Pa.
West, Roberta M Philadelphia, Pa.
•West Ellis Hospital Chattanooga. Tenn.
White. A. J., M. D Boston Consumptive Hospital, Boston, Mass.
Whiting. Dr. A. D Med. Dir.. Germantown Hospital, Philadel-
phia, Pa.
Williams, H. C, M. D...Staten Island. New York City.
Williams. Dr. I. D Supt.. C. B. Towns Hospital. New York City.
Wilson, Margaret L Supt.. Philadelphia Orthopedic Hospital and
Infirmary for Nervous Diseases. Philadel-
„ phia. Pa
Wise, Helen V University Hospital, Baltimore, Md.
Walker, John W Trinity Mission Hospital, Winner, S. D.
Welden, Mrs. E Wesley Homeopathic Hospital, Wilmington,
Del.
Weeks. David F N. J. State Hospital for Epileptics, Skillman,
N. J.
Wharton, Bromley Secy.. Board of Public Charities. Philadel-
phia. Pa.
THE MODERN HOSPITAL
327
Whitney. Mary L Supt.. Ware Hospital. W(>rce-;ter Mass
Willis, Edith T Supt.. Good Samaritan Hospital Vincenncs
Ind.
Wilkes, P. C Supt.. Baptist Memorial Hospital. Memphis.
Tenn.
Wehmeth. F. L State of Nebraska.
Wilson. Martha Pres., Auxiliary Board Children's Hospital.
Chicago, III.
Wilson. R. J Dir. Board of Hospital, Dept. of Health.
New York City.
Wilson, Geo. S Secy.. Board of Charities, Dist. Bldg., Wash-
ington. D. C.
Wolcott. Miss Grace L...Supt.. Waterbury Hospital, Waterbury. Conn
Wood. Kathryn W Directress, Burke Foundation, White Plains
N. Y.
Woodside, Margaret N...Supt.. Braddock General Hospital, Braddock,
Pa.
Worth, Collen M Supt., Trenton Memorial Hospital. Trenton,
N. J.
Wright, W. E Acting Supt., Burke Foundation, White
Plaines, N. Y.
Wright. Mrs. Lucia M...Supt., Homeopathic Hospital. Reading, Pa.
Wright, Ethel S. S. Dept., St. Christopher Hospital.
Xavier, Sister Mary Supt., St. Joseph's Hospital, Reading, Pa.
Yearick, H. G Supt.. St. Luke's Hospital. Spokane. Wash.
Yingst. Edith Supt.. Carlisle Hospital. Carlisle, Pa.
*Youns. Dr. C. S Washington Park Hospital. Chicago. HI.
PAPERS AND REPORTS PRESENTED AT ATLANTIC CITY MEETING
Reports Show Gratifying Progress of Association — Papers Indicate That Grave Hospital
and Nursing Problems Presented by War are Well in Hand
The War and the Civil Hospitals
Bv ARTHUR B. ANCKER M.D., President American Hospital Associa-
tion, Superintendent St. Paul City and County Hospital.
St. Paul, Minn.
The American Hospital Association, assembled at this
twentieth annual convention, finds humanity passing
through a crucial period. All the world is at war. When
we met, one year past, a few months after the war dec-
laration, the country was slowly but effectively mobilizing
its resources. Today America has become a mighty fac-
tor in the great struggle for freedom. Nothing else mat-
ters now but winning the war. To this cause America is
dedicated — its spirit and its might. To this cause we
here must contribute. The civil hospitals have at all
times and especially now an important field of work. This
work must be done and done well.
The great war has brought the civil hospitals of Amer-
ica face to face with serious problems. To the end that
the health of our Army shall be safeguarded, civil hos-
pitals have given willingly of their clinical and nursing
staffs. They must give more and still moi'e. The con-
tinued call for nurses for home and foreign service is fast
reducing the graduate nursing personnel of the hospitals.
The civil hospitals will have an important part in the pro-
viding and training of future medical officers and nurses.
At the same time they must make adequate provision for
the hospital care of the civil population. The part the
civil hospitals are to take in the reconstruction and re-
habilitation is as yet undetermined. The whole problem
is difficult. The adoption of a comprehensive, cooperative
program is imperative.
The civil hospitals have unhesitatingly accepted calls
for war service. They expect further calls of various
kinds. Official announcement has been made, however, by
the Surgeon Genei-al of the Army that civil hospitals will
not be used for the pi-esent by this Department for the
care of returned soldiers. Limited use is now being made
for this purpose of certain civil hospitals. The extension
and development of existing civil hospitals under govern-
ment direction has been advocated as a necessary policy
instead of the present plan of using convei'ted army posts
and Federal hospitals and also the building and equipping
of special military hospitals. The former would seem to
be consistent with economy and with efficiency of service
to both the military and civil population. It would not
result in the complete breaking up of the clinical and
nursing organizations of the civil hospitals. It should
cost less than for independent construction and new equip-
ment. These policies are worthy of careful consideration
by this convention. Wise statesmanship will prompt those
representing the civil hospitals, individually and collect-
ively, to anticipate that the Government will later make a
wider use of civil hospitals for returned soldiers. If the
war continues long, necessity will compel such action. It
is our obvious duty to help the War Department foresee
these hospital war needs, as well as the needs of the civil
population, and to plan to meet them constructively. If
we so fail, we shall be "weighed in the balance and found
wanting."
We are met here now to discuss and deliberate upon
these hospital problems of today. They are not alone in-
dividual problems, but the hospital and health problems of
the nation at war. There are wide differences of opinion
concerning the merits of the numerous hospital medical
and nursing programs designed to meet these rapidly in-
creasing problems. Vital issues have been raised. They
must not only be discussed here but settled. To this end
concerted action is imperative. Representatives of sev-
eral important Federal departments are to take part in
our program. Representatives of the Surgeon General's
office will discuss certain hospital war problems especially
in their relation to civil hospitals. They will be expected
to answer questions. They should tell us of the hospital
and nursing programs of the army and, above all, what
further calls for war service will be made upon the civil
hospitals. The civil hospitals have a right to know.
The great crisis has not found the American Hospital
Association unmindful of its responsibilities. Its War
Service Committee has been most active. Mr. Richard P.
Borden, secretary of the committee, has been regularly in
Washington at least three days a week. The report of
this committee is commended to your careful attention. It
emphasizes our added war obligations. Some of the hos-
pital problems confronting this committee, as well as
those confronting the Legislative Committee, have been
made known to you from time to time through special
bulletins, and your advice and assistance solicited. The
president urges your favorable consideration of the rec-
ommendations of these two committees. By all means
definite action should be taken on the proposed Federal
Inheritance Tax in its relation to hospitals as recom-
mended by the Legislative Committee.
The American Hospital Association has for many years
been a voluntary personal association of hospital people.
As such, it has prospered and rendered helpful public
service. There has been a growing feeling, however, that
the Association should develop along broader lines and
that for this purpose the adoption of a plan of reorganiza-
tion is necessary. From time to time it has been sug-
gested that this Association should become an Association
of American Hospitals. The war has produced added rea-
sons in support of this proposal. Accordingly, at the last
328
THE MODERN HOSPITAL
meeting of the trustees, the president was authorized to
appoint a special committee to consider and report on this
question. The committee has reported. Its report has
been placed in the hands of every member of the associa-
tion. It cannot fail of adoption.
Your president urges the adoption of this proposal for
reorganization as it stands— not only because it will help
to make possible "an association of American hospitals to
promote the welfare of American hospitals and to protect
the interests of hospitals and hospital work"; not only be-
cause it will mean more effective war service organiza-
tion; but because it paves the way for real effective hos-
pital standardization. Experience of over thirty years in
active hospital work compels me to assert with all the
strength I have that standardization and classification of
hospitals must and will come directly from the initiative
of the hospitals themselves. Standardization of hospitals
now on any basis except as affected by the war is useless.
Yet the American Hospital Association may well now at-
tempt a beginning in this direction through "the simple
yet effective standardization from election to member-
ship." It is the honor of a life-time to be here today and
recommend, as your president, the adoption of this re-
port, knowing full well, as I do, that in the progressive
development of the American Hospital Association it will
mark an historic milestone.
Let us proceed then to our program. Let us be tem-
perate in our debate and constructive in our criticism and
concerted action. Let us so conduct ourselves on this his-
toric occasion that it may be said with all truth that the
twentieth annual convention of the American Hospital
Association was a real demonstration of the power of the
organized hospitals of America to think and to plan con-
structively in terms of the present great crisis and for
the future.
Resolutions Presented by the Resolutions Committee
Control of Venereal Disease
Resolved, That the Amei'ican Hospital Association heartily endorses
the program of the War Department for the control and treatment
of venereal disease, and that the hospitals of the count i-y be ur^ed
to cooperate with this program in every way, and particularly, by
developing, or when necessarj* establishing, clinics for treating venereal
disease, and by opening their wards to patients with these diseases
who require bed care ; and be it further
Resolved, That the Committee on Out-Patient Work be authorized
and directed to prepare a suitable statement incorporating this reso-
lution, to be sent, after approved by the president of the association.
to the proper officials of the hospitals of the country.
Hospital Assistants
At a conference recently held in Washington it was
Resolved, That civil hospitals which have the necessary facilities be
encouraged to arran??e for the training and use of hospital assistants
according to the plans and qualifications of the Army School of
Nursing. Such hospital assistants should be enrolled through the
American Red Cross with the understanding that they will accept
ser\'ice as required either — (1) With the hospitals in which they are
trained: (2) with the American Red Cross; or (3) in army hospitals.
Inasmuch as the foregoing recommendations involve a plan of
action which implies the cooperation of the civil hospitals, the Red
Cross and the Medical Department of the army, the American Hospital
Association requests an early conference with the other parties con-
cerned for the purpose of arriving at a complete working under-
standing of all the details of the proposed agreement.
Resolved, That the association hereby records its hearty approval of
the principle of the proposed cooperative scheme and urges its mem-
bers to participate in every possible way.
Graduate Medical Students
The American Hospital Association desires to emphasize the neces-
sity, for both civil and military reasons, of continuing the established
method of providing post srraduate clinical training in the civil
hospitals for the graduates of medical schools.
Under laws and regulations recently enacted, the assignment of
graduate medical students to hospitals and the conditions of such
assignments rests entirely with the military authorities.
Resolved, That a committee of seven members, representative of
various types of hospitals, be appointed by the president for the
purpose of promoting a proper solution of the educational, miHtary,
financial and administrative problems which are bound up with this
question and that such committee be empowered to represent this
association in negotiations with the War Department.
Resolved. That the president of the association shal
member of thi:
c-offici(
Hospital Employees
Resolved. That this association greatly appreciates the concern
which the Acting Secretary of War has shown in the difficulty of
hospitals with regard to employees, and, in accordance with his ex-
pressed wish, makes the following suggestion — viz. : that all male
employees of hospitals shall, upon request of hospitals to the i-raft
boards, be exempt from military duty during the period of hospital
employment, this to include engineers, fireman, orderlies, porters, chefs,
pharmacists, laboratory and x-ray technicians, ambulance drivers
and chauffeur:., and others especially trained or accustomed to hos-
pital service ; it being understood that hospital authorities shall not
claim exemption when the work may be done by women or by men
incapable of militai-y service and that any institution violating this
understanding shall be entitled to no further recognition.
Organization op Civillan Physicians fob Military Service
Resolved, That in view of the inevitable difficulty in supplying a
sufficient number of physicians to meet the military and civilian re-
quirements and the necessity that certain of the most skillful members
of the profession should remain on duty with hospitals, medical schools,
public health organizations and to meet other imperative professional
requirements, it is the sense of this association that some organiza-
tion should be perfected whereby such physicians may be made avail-
able, in their several communities, to care for returned soldiers in
hospitals in their vicinities.
The association gratefully acknowledges receipt of communication
from the Acting Secretary of War which reads in part as follows:
"As to physicians, we are aware of their need in civil as well as
military establishments and attention will be given to the fullest
possible extent to such measures as may be necessary to safeguard
the civil hospitals in this respect."
Recognizin;; with the War Department the necessity of such an
interpretation of the man-power law as will "not seriously interfere
with hospital work or with the care of the public health," the
American Hospital Association records its hearty approval of the
instructions to draft boards recently issued by the Provost Marshal
General. The association, however, senses a certain danger in the
fact that discretionary power in this matter has been entrusted to
several thousand boards, whose interpretation of instructions issued from
Washington is likely to vary widely and whose interpretations in
the mass may, notwithstanding the clearly expressed intention of the
Secretary of War and of the Provost Marshal General, take on a form
unduly destructive of civil hospital organization or unduly obstruc-
tive to the program and needs of the medical department of the
army.
The association is unofficially advised that this subject is now re-
ceiving the considei-ation of the authorities at Washington ; it urges
that steps be taken speedily to insure reasonable uniformity, in the
interpretation of the law and the regulations thereunder, reasonable
protection to the civil hospitals and due recognition of the military
needs. But, while favoring speedy action, the association feels that
it is highly important that its representatives should be given an
opportunity to be heard on the subject and hereby authorizes the
president of the association to take such steps as may be expedient
to secure a hearing.
Red Cross Survey
Resolved. That this Association heartily endorses the proposed Survey
of the American Red Cross for the purpose of ascertaining the forces
available for nursing service in the United States and urges all hos-
pitals and public health organizations, whether represented in this
association or not, to aid in every way to secure a rapid and accurate
result.
Affiliation With Army Training School for Nurses
Resolved, That this association fully appreciates the probable value
of an army training school for nurses, under such circumstances as
will assure to the pupils a complete and adequate professional educa-
tion, as may undoubtedly be given in such permanent institutions as
the Walter Reed and Letterman Hospitals and perhaps under other
available opportunities ;
That civilian hospitals should cooperate in evei-y way to aid such
plan, by affiliation, when it may be of mutual advantage and to the
advantage of the pupils concerned, or by any other reasonable method:
That the action of this association should be and is governed, not
by a selfish regard for the institutions which it represents, but by an
active and sympathetic concern for the men who. by reason of
patriotic service, may become patients in army hospitals ; and for
the pupil nurses, who, from an equally patriotic impulse, may enter
the military hospitals ;
THE MODERN HOSPITAL
329
Thai, actuated l,\
the
char;
of both
the civilian and the military hospitals should give very serious
sideration to the proljlems involved, which include the period in the
ciurse of training at which pupils could be exchanged to the advantage
of all concerned : the education which the pupil is to receive in the
respective institutions ; the opportunities for such education ; full
assurance that the contemplated program may be carried out by
Itoth parties to the advantage of the pupils : and a complete under-
standing and acceptance of the conditions by the students concerned :
and that finally, if the above requirements are satisfactorily fulfilled,
in the estimation of the institutions concerned, the agreement, if
any. between the parties, should be set forth in a written contract
embodying all the substantial terms and conditions of the engaa:ement.
Use of Existing Hospital Facilities
Ne^olvt'd, That this association most heartily approves the plans
of the War Department to provide for the care of our sick and
injured soldiere by a most ample provision of hospitals both at home
and abroad, and. knowing from experience that the supply of hos-
pital equipment and hospital personnel is very limited, respectfully
represents that conservation of both of these essential elements is
imperative and suggests and advocates that for this reason existing
hospital facilities should be utilized as -much as possible by appropriat-
ing spaces in hospitals not necessary for civilian requirements for
use as military wards, by the temporary construction of such wards
in proximity to present hospital building, by arranging for groups
of hospitals to accommodate the patients of one of the group so
that it may be taken over during the period of the war for military
purposes or by such other means as may seem advisable, thus avoid-
ing the unnecessary' duplication of administrative and scientific hos-
pital facilities such as operating rooms, laboratories, x-ray apparatus,
and the skilleti personnel in charge of them.
Nurses in Captivity
Whereas. The ComptroUer of the Treasurj- has recently ruled that
American army nurses held as prisonei*s of war by an enemy nation
are not entitled to pay during captivity, on the ground that, as civilian
employes, the.v are not included in the statute allotting pay to mem-
bers of the Regular Army, privates, and officers, commissioned and
non-commissioned : and
Whereas, the army nurse is not a civilian employe but for eighteen
years has been by law an integral part of the regular army : therefore
be it
Resolved. That the American Hospital Association at Atlantic City
in convention assembled this 2.^th day of September requests and
urges that the Secretary of War and the Secretai-y of the Treasury-
take such steps as niay be necessary to remedy this grievous evil.
Federal Inheritance Tax Bill
Recognizing that the charitable hospitals of the country, many of
which are members of this association, are to a considerable extent
dependent upon bequests and endowments with which to carry on
their benevolent work, including the work of training increased num-
bers of nurses for war service, the American Hospital Association
desires to go on record officially concerning the provisions of the
proposed Federal Inheritance Tax Law, which, if enacted, threatens
to inflict an unjust burden upon charitable institutions, including
hospitals not operated for private gain : therefore be it
Resolved. That the American Hospital Association, assembled at
its twentieth annual convention, earnestly protests the enactment of
this provision of the Federal Inheritance Tax Law and lends its
entire support to the enactment of the Tax Exemption Bill intro-
duced by Senator Hollis, which is intended to protect the future of
hospital endowment and maintenance, and be it further
Resolved. That the Legislative Committee be instructed to make
known this attitude of the American Hospital Association to the
Finance Committee of the Senate and do eveiTthing within its power
to persuade said committee to report the bill favorably, and be it
further
Resolved. That local hospitals represented at this convention be
r-equested to write their local senators and representatives and urge
them to support the Hollis Bill.
Report of the Audit Committee
Your committee was appointed at the session of the
convention held on Tuesday, Sept. 24, 1918. No prelimin-
ary work had been done prior to this time. The commit-
tee discovered many conditions needing attention, but the
books have been kept in such a manner that no satisfac-
tory audit can be made at this time. There have been
various changes in the personnel of the office, together
with a change in the executive secretaryship, so that there
seems to have been no complete or definite transfer of in-
structions as to the work required in so far as it relates to
the keeping of these accounts.
For the period from .January 1, 1918, to August 31,
1918:
Gross income $9,807.63
Gross expense 5,827.63
Balance $3,980.00
Statement of Receipts and Expenditures From Janu-
ary 1, 1918, to August 31, 1918
receipts
Balance in banks Jan. 1, 1918 $4,422.98
Drawn from Union Trust Co. of Chi-
cago and invested in four Libertv
Bonds ■. 100.00 $4,022.98
Active membership fees. . .$2,875.07
Associate membership fees 372.00
Life membership fee (in-
vested in Liberty Bond).. .50.00
Commercial exhibits 2,154.15
Interest on deposits 42.50
Miscellaneous receipts .... 280.93 5,784.65
Total receipts $9,807.63
expenditures
Administrative Expenses —
Office of the president.. .$ 275.78
Office of the secretary:
Salaries ." . . . 1,450.00
Supplies 966.64
Traveling expenses .... 545.47
Office equipment 160.48
Proceedings for 1917 1,194.30
Miscellaneous 91.50 $4,408.39
Convention Expenses —
Commercial exhibits ....$ 552.51
Committee Expenses —
Committee on war service 465.24
Committee on out-patient 125.71
Total expenditures . . .
$5,827.63
$3,980.00
The receipts from life memberships to January 1, 1918,
amounted to $357.29. There have been four memberships
since that time, making total to credit of endowment ac-
count, $557.29. Of this amount $450 has been invested in
Liberty Bonds, leaving a balance with the treasurer on
September 27, 1918, of $107.29.
There seems to be a diflference in the cash balance be-
tween our accounts with the Washington Loan and Trust
Company and the Union Trust Company of Chicago, as
shown by cash account and that of the bank books, of
$42.93. This difference, however, is not a shortage, as the
bank books show this amount in excess over the amount
shown by the books of the Association.
summary of balances AS found.
Balance Washington Loan and Trust Co.. Jan. 1, as per bank
book $4,172.17
Less checks No. 304 and 307 out — Aug. 22 and 29, 1918 57.07
Correct balance as shown 4.115.10
Balance as per bank book. Union Trust Co., Chicago 357.29
Balance Jan. 1, 1918 — all accounts 4.472.39
Balance as per cash account 4,072,17
Plus balance in Chicago 357.29
Total $4,429.46
Difference between balance as should be and that shown by cash
account and balance in Union Trust Co.. Chicago 42.93
The Commercial Exhibit account shows deposits equal
to the amount entered as cash receipts, but there is no
330
THE MODERN HOSPITAL
evidence that the amounts so deposited still remain to the
credit of the association.
In the petty cash account from January 1, 1918, to
March 1, 1918, no account apparently has been kept of the
receipts and expenditures, but this account may have been
inactive during that period.
There is no record for the authority of expenditure of
money for goods purchased by the association. Purchase
order blanks have been prepared for this purpose, but
they have not been used.
Throughout all of the records there is a general omis-
sion of the dates of i-eceipts and expenditures, so that it
is difficult to make a satisfactory audit of accounts.
The plan also required headings for all accounts, but
these are omitted in many instances, together with the
numbering of the pages.
The Commercial Exhibit account on Sept. 20, 1918,
shows a credit of $4,8.56.80; of this amount, $3,666.86 is
shown as cash received and a balance still due of $1,170.
The contract with the Commercial Exhibitors calls for a
payment of 50 per cent of the amount due ten days from
date of contract and the balance on or before August 25,
1918. The time of payment within the specified time has
not been enforced.
There is no indication of any misappropriation of any
of the funds of the American Hospital Association, but
many of the items are incomplete so that it is absolutely
impossible to check receipts and expenditures readily, or
to balance the books in their present form. The commit-
tee is unanimous in believing that the plan itself is able
to meet all requirements, but that it has not been main-
tained in accordance with the original design.
RECOM MENDATIONS.
We recommend that the books of the association be
audited and a balance struck as of September 30, 1918, and
that the amount then shown be the sum on which all fu-
ture calculations be based. Then, with the correct use of
the plan as previously approved by the board of trus-
tees, and in accordance with the system originally made,
there should be no further difficulty experienced.
That the control and direction of financial transactions
of the executive office be assumed by the executive sec-
retary. This is the plan adopted by the trustees about
one year ago, but it is not now in effect.
That a weekly and monthly financial report be sub-
mitted by the executive secretary to the president and
treasurer and that a monthly report be submitted to the
board of trustees and officers on forms already provided.
That all accounts be closed for the fiscal year on De-
cember 31, and that an annual report as of that date be
prepared and presented to the boai'd of trustees, accom-
panied by the bank statements, showing the amount on
deposit to the credit of the association.
That a professional audit of accounts of secretary's
office and treasurer's accounts be made as of December
31 of each year and at the close of the month previous
to the date of convention.
That the present system of accounting be retained and
that its provision for showing the financial conditions of
the association at all times be used.
That a finance committee of three be appointed, of
which the treasurer shall be a member.
That an endowment committee be appointed which shall
consist of the board of trustees and the treasurer, which
committee shall direct the investment of all moneys from
life memberships and gifts to this fund; and that the
income from this fund only shall be used for current ex-
penses.
That the rule which provides for a payment by com-
mercial exhibitors of 50 per cent of the fee within ten
days after signing contract and payment of the balance
be insisted upon prior to the convention.
Cornelius S. Loder,
Chairman.
S. J. Barnes,
Francis 0. Bates,
Rosa Saffier.
Report of the Accounting Committee
The present unsettled state of our hospitals, due to pre\'ailing
conditions occasioned through the war, is recognized and appreciated
by your Committee on Accounting. They discussed the subject by
mail with some of the officers of the association, and they attempted
obtaining opinions from various members as to needed improvements
of an office, clerical or accounting character. The result was not
satisfactory, due to the absence of many of the leaders, and because
of the uncertainty in their own minds of those who did respond as
to just what it was best to do at the present time.
Those in attendance at the Cleveland Convention last year will
recall the committee's making certain concrete, definite recommenda-
tions that were unanimously approved. Those who were present
may recall the committee's urging you to adopt those suggestions,
for we hoped to work out a general .scheme which would include some
one specific standardization of plan each year until the entire system
had been covered. We may well inquire how many returned home
and instituted the betterments suggested through this committee.
The American College of Surgeons is in process of collecting data
on important hospital problems, and its report promises constructive
help. These data are collected by personal visits. And, while the
work is still in its beginning, it is already the basis for a series of
publications now in preparation. Among them such problems as
these are included : What is the responsibility of a Board of Trustees
to its hospital? What is a practical working relationship between
the trustees and the hospital staff? The hospital superintendent and
his relation to the governing board.
The College now has in the form of proof a set of case records
in which the aim has been to make them as simple as possible and
yet adequate. The experience of the army and of the navy has been
utilized in the preparation of these forms, which is a matter of vital
importance when we consider that, at the end of the war, some twenty-
two thousand doctors will return to civilian hospitals trained in military
record keeping. All of these pamphlets will be sent to each hospital on
the continent without cost. This work is an expi-ession of the desire
of the medical profession for better care of sick people.
The Accounting Committee desires to correlate all thought and
effort relating to hospital improvement problems by all interested
groups, and they urge hospitals to adopt that which seems best.
We, therefore, earnestly invite and urge cooperation with all groups
working on these problems.
We have therefore determined to present just one plan that can
readily be utilized by every hospital without any difficulty. It con-
cerns purchases, from their order to their payment.
(1) Purchase orders in triplicate form, on different colored paper,
typed or hand-written in one operation.
(A) The original is sent to the party from whom the goods
are desired.
(B) The first carbon copy for the housekeeper, receiving
(C) The second carbon copy retained by the office for ref-
erence purposes.
The first carbon copy (B) of this form is retained by the re-
ceiving clerk until the goods arrive with invoice. The Purchase
Order Form and the invoice are both checked and compared. If cor-
i-ect, they are passed to the clerk, bookkeeper or Superintendent, after
being approved by the receiving clerk, for such further entries or
attention as is customary or desired, but usually held until the bill
is received.
This checked purchase order and checked invoice with the bill is
then passed to the committee that audits all such orders for pay-
ment. If the House Committe, Finance Committee, Budget Committee
or whoever is required to give the matter attention, passes it, and
it is O. K'd. by the superintendent, it is then ready for payment.
A check is used in simple vouchc- form with a plain buff colored
paper, numbered same as check, and both are typed in one operation
with the aid of a carbon. In addition to containing the ordinary
matter, it is arranged so that the name and the address of the
person for whom the check is intended can be inserted together with
the voucher number and other similar desired information. This
check requires only the signature of the treasurer, and it is then ready
for mailing in one of those so-called window envelopes.
THE MODERN HOSPITAL
331
When the check has passed throujrh the bank, it is then filed in
numerical order.
The carbon copy of the check, with the bill, invoices, and copy of
purchase order are attached together and filed with paid orders of
that month, so that the entire transaction from the ordering of the
goods, including the invoice and bills and a copy of the payment
on each separate purchase, is complete together, and shows the entire
transaction from its commencement to its termination.
All other bills of that month are together in this one envelope or
file, and each part of the transaction is cross-checked.
In many hospitals these various parts to an order are kept separately
so that it is necessary to look in several different places when com-
plete information about any transaction is required.
It therefore seems to your Committee of Accounting that, irrespec-
tive of conditions within your own institution or general affairs,
this plan can be instantly adopted to your benefit and advantage.
Cornelius S. Loder. Chaii-man.
Report of the Legislative Committee
The present constitution of this association provides
that the Legislative Committee shall, so far as possible,
inform itself concerning all legislative procedure affect-
ing the association or the interests which it represents
and communicate the same to the association by an an-
nual report or by such other means as the trustees may
approve. It seems to be the established custom of the
Legislative Committee to report to the association at each
convention about legislation of particular interest to hos-
pital people. As a rule, such reports have described legis-
lation already on the statute books. While it is conceded
to be an advantage to hospital people individually and
collectively to have such information, it is the opinion of
your Legislative Committee that for constructive pur-
poses such procedure can be likened to the policy of lock-
ing the barn door after the horse has been stolen. The
making of such reports and the listening to them on the
part of the association does not make it possible for the
association or its Legislative Committee to exert influ-
ence in behalf of wise hospital legislation and against un-
wise legislation. -A.long these lines, therefore, the com-
mittee has nothing to report.
Two important legislative matters have been assigned
to the Legislative Committee during the year, and a third
responsibility has been assumed by the committee.
FEDERAL INCORPORATION OF THE AMERICAN HOSPITAL
ASSOCIATION
On December 12, 1917, the Legislative Committee was
requested to draft a bill for the Federal incorporation of
the American Hospital Association and submit the same
to the trustees for approval. These instructions wei'e
tomplied with, but for three months the bill was pigeon-
holed in Washington. When returned to the committee
in the same form but with instructions to redraft it for
approval by the trustees, no fui'ther action was taken
toward its introduction. It was the opinion of the United
States senator who had agreed to sponsor the bill, if
introduced, that it would be side-tracked because of im-
portant pending war legislation. The committee recom-
mends that the association go on record at this conven-
tion in favor of incorporation of the association provided
that state incorporation be sought if Federal incorpora-
tion be found impossible at this time.
THE FEDERAL INHERITANCE TAX
The procedure followed by the Legislative Committee
in opposition to this provision of the proposed Federal
Tax Law and in support of the Rainey Bill, H. R. 9223,
is familiar to the members of this association. Copies
of the Rainey Bill and the Bulletin of the Legislative
Committee on this subject have been made available to all.
In spite of the fact that the hospital point of view as em-
phasized by the Legislative Committee is not likely to
be fully accepted by Congress, the committee recommends
that the association go on record as opposed to the Fed-
eral Inheritance Tax provision of the Tax Bill as related
to hospitals, and in support of the Rainey Bill; also, that
the Legislative Committee be instructed to send a com-
munication embodying the attitude of the association on
this proposed legislation to the proper committees in the
United States Senate and in the House of Repi-esenta-
tives.
SICKNESS AND HEALTH INSURANCE LEGISLATION
So far as the members of this committee know, no
scheme of so-called cumpulsory sickness or health insur-
ance has been enacted by any state legislature in this
country. However, legislation in eight states has been
enacted authorizing the appointment of commissions to
study the subject and report recommendations. These
states are California, Connecticut, Illinois, Massachusetts,
New Jersey, Ohio, Pennsylvania, and Wisconsin. The
Massachusetts State Commission made a report on social
insurance in January, 1918. The other state commis-
sions, most of them only recently appointed or organized,
are now at woi'k. One or two are already beginning to
analyze their data, tabulate their findings and consider
legislative recommendations.
The committee has corresponded with the commissions
of seven states. It believes that hospitals are vitally con-
cerned with health insurance proposals. In fact, there
can be no comprehensive plan of compulsory sickness or
health insurance without hospitals or a hospital system.
The social service department of modern hospitals and
dispensaries are prime essentials to any program for
health insurance, if health insurance contemplates med-
ical and hospital care to the extent of reconstruction and
rehabilitation of the individual. Health insurance will
revolutionize hospital responsibilities.
With the thought that these commissions might soon
recommend legislative proposals, the committee has
sought to learn their plans for the use of existing public
and private hospitals and their ideas as to the sufficiency
of medical and hospital care to be pi-ovided for the indi-
vidual, as well as what they are considering as the pi'oper
basis for the determination of rates and charges
of such medical and hospital service. The information so
obtained is most interesting. It indicates the necessity
of prompt and effective action on the part of the American
Hospital Association, as well as the various state hospital
associations, if they expect to be the factoi's they should
be in legislative proposals having to do with compulsory
sickness or health insurance.
Hospital workers and hospital associations seem to have
been somewhat indiffei^ent heretofore to the subject of
hospital benefits under Federal and state workmen's com-
pensation commissions. If they have not as yet learned
the injustice resulting to injured workmen and to hos-
pitals themselves from such indifference, then they never
will. Too long have we hospital people sat idly by and
let state legislatures and workmen's compensation com-
missions make plans for the hospital care of injured work-
men without careful thought for the sufficiency of the
care and with almost no regard for the cost to the hos-
pital of the service rendered. Although there is a ten-
dency to enlarge medical and hospital benefits in new laws
and amv idments, it is true that most of the compensa-
tion states place an absurdly low limit both as to the
length of time and as to the amount allowed for medical
and hospital care. Some states give no medical benefits
while some place the time limit as low as two weeks and
332
THE MODERN HOSPITAL
the cash allowance as low as $25. Do they call this
adequate medical and hospital service? And in addi-
tion, few states within the knowledge of the members of
this committee have given more than a limited recogni-
tion in the workmen's compensation legislation or their
administration of the same, to the principle of "hospital
cost for hospital service rendered" to the injured work-
man.
Under present compensation laws, generally speaking,
the state seeks to provide adequate hospital and medical
care for the injured workman as a matter of justice; it
must be paid for by the employer as a proper charge
against industry; the state as the protector of human
life has so decreed. Then the state talks to the hospital
providing care in this inconsistent language: "It makes
little difference to the state what this service costs the
hospital ; we will fix the rates and determine the num-
ber of days to be paid for; you can do charity work for
the state and for the employer." As a typical example,
only recently one state commission congratulated itself,
and the hospitals of the state as well, that it had in-
creased the weekly rate for such hospital service from
$1.5 to $18 a week, although this compensation was
considerably less than the average daily per capita cost
of the service rendered.
But pass over the question of fair compensation to hos-
pitals. Think what this policy of the state means — this
policy of arbitrarily limiting by legislation or otherwise
the number of days or weeks of hospital treament. It af-
fords little opportunity for the complete restoration of
the workman seriously injured in industry. In a large
measure, it defeats the fundamental purpose of work-
men's compensation. Unless we hospital people awaken
to the danger and prevent it, not only will hospitals
have precisely the same experience under health insur-
ance laws, but, what is of far greater importance to hu-
manity, the sick, who should be entitled to complete re-
habilitation as a matter of justice, will become, in part,
objects of charity.
Now what is the present attitude of these commis-
sions toward the question of compensation to hospitals?
One commission which has recommended a bill has not
taken up the question. Three commissions have not con-
sidered this phase of the subject, but are considering
the general proposition of the necessity of health insur-
ance. One commission has a tentative agreement to the
effect that the cost must be based on the actual cost to
the hospital, all arrangements to be left to the adminis-
tering department and not to be written into the law.
One commission has formulated no conclusions as to the
best method of meeting this problem but wishes that the
American Hospital Association would make suggestions
as to how medical treatment could best be administered
under health insurance. One commission, although it has
formulated no definite policy as to health insurance, has
gone on record in favor of the most adequate medical and
hospital care as a fundamental in any health insurance
scheme, and has recognized that hospitals cannot be ex-
pected to furnish service for less than cost. To be sure,
these commissions have not as yet formulated much of
anything in the way of policy or program for legislation.
Yet some have official or unofficial opinions regarding the
compensation question. The important thing, however,
for our purpose is that practically all of them seek in-
formation and desire assistance.
Your Legislative Committee believes it is the obvious
duty, both of the American Hospital Association, through
its Legislative Committee, and of the state hospital as-
sociations, to take an active part in advising and assist-
ing these commissions as regards hospital and medical
benefits. The letters to your Legislative Committe from
these commissions may very well be interpreted as invi-
tations to the American Hospital Association to do so.
Your Legislative Committee, therefore, recommends:
(1) That the American Hospital Association go on
record in favor of hospital and medical benefits to those
insured under Sickness or Health Insurance laws to the
extent of restoration in wholesome working and living
conditions, so far as it is possible; (2) That the American
Hospital Association go on record in favor of the principle
of "hospital cost for hospital service rendered" as applied
to the proposal for compulsory sickness or health insur-
ance; (3) That the Legislative Committee, subject to the
approval of the Board of Trustees when the association is
not in session, be and is hereby instructed to render such
advice and assistance as it can to the various state health
insurance commissions and to urge these commissions to
include in their recommendations for legislation the prin-
ciples emphasized above.
Howell Wright, Chairman,
Oliver H. Bartine, •
Geo. O'Hanlon, M. D.
Report of the War Service Committee
At the last meeting of this Association resolutions were
adopted in which it was set forth that it was its desii'e
to cooperate to the greatest possible extent with military
authorities and with the .American Red Cross, and that,
in order to be fully prepared for service, a committee be
appointed "which shall, as far as possible, inform itself
of all military needs in which hospitals may be con-
cerned, be in readiness to consult and advise with mili-
tary authorities, to take such action as may be important,
and, in general, to assist in every way where hospital
service may be of value to the country."
Following these resolutions your trustees appointed a
committee which has since been known as the War Serv-
ice Committee of the American Hospital Association, and
this committee has. in accoixlance with your desires as
expressed in the resolutions, endeavored to keep informed
as to military hospital needs and to cooperate and assist
in every way possible.
It was deemed important, in view of rapidly changing
conditions, to have a representative regularly in Wash-
ington, and headquarters were therefore established at the
Washington office of the association. The Statistical De-
partment of the Medical Section of the Council of Na-
tional Defense was collecting information which coin-
cided in a large degree with that desired by your com-
mittee, and at its invitation the freedom of this office was
available. The chairman was also made chairman of the
Hospital Committee of the Council of National Defense.
This association and collaboration have been of great
benefit to us, and we hope the benefit has been mutual.
.A.lthough both organizations were serving in a common
cause, nevertheless we are glad to express our apprecia-
tion of this friendly cooperation.
It was soon evident that with the hospital as a basis
the work of the committee was led into many and varied
fields. Questions involving physicians, interns, medical
students, medical schools, nurses, nurses' aids and their
training, supplies, construction of civil hospitals, addi-
tional facilities for the care of congested industrial popu-
lations, and questions under the Capital Issues Commit-
tee, War Industries Board, Federal Board for Vocational
Education, War Risk Insurance Bureau, and Public
Health Service, all concerning important issues collateral
THE MODERN HOSPITAL
333
to Hospital problems, as well as the more definite prob-
lems of hospital planning, construction, equipment and
administration were met. Every week has brought new
problems, and these your committee, after careful consid-
ei'ation, has endeavored to aid in solving.
It was essential to have at hand as complete informa-
tion as possible, and from time to time questionnaires
have been issued and information has been sought from
members of the association and from hospitals in general.
It was realized that hospitals had been asked for much
information by many different organizations, authoritative
and otherwise, and were perhaps weary of responding
to repeated interrogatories involving many repetitions,
but the questions which have been asked have been ones
with definite relation to a pertinent problem. It is to be
regretted that the responses were not as universal or as
carefully made as was hoped, and this failure to respond
prevented an accurate and complete diagnosis of condi-
tions, although affording a basis for estimate. Undoubt-
edly many other questions will be asked before our work
is done, by others, if not by your own representatives.
May we express the hope that, however tiresome and ap-
parently unimportant they may seem, prompt and careful
replies b? made.
From the first, certain policies have been advocated by
the War Service Committee. Most important are the
following :
1. Existing hospital facilities shoidd be used so far as
possible for military purposes — The Association, by a res-
olution adopted last year, advocated this policy, and your
committee iias gained no information during the year
which would lead to a change of opinion. Under great
misapprehension the authorities have apparently believed
that it was the intention to place soldiers in spaces neces-
sary for civilian occupation and intermingled with civilian
patients. This was never advocated, but, as a matter of
necessary conservation, we have believed, and still be-
lieve, that the administrative departments of hospitals,
such as operating rooms, laboratories, and x-ray facili-
ties could be used most economically and efficiently, simply
by utilizing vacant spaces in hospitals for military wards,
or by the construction of additional living spaces in prox-
imity to existing hospitals where this could be done.
Wp have believed that it was a fundamental necessity
to hospitalize returned soldiers as near their homes as
possible. This policy is the announced policy of the Sur-
geon General of the Army. But to accomplish this over
one hundred thousand beds must be provided in over forty
different locations, and the cost of construction and equip-
ment of complete operating and scientific facilities on such
a scale is apparent. It is also to be considered that a very
small proportion of returned soldiers will require opera-
tive interference, while the comparatively few that do
are entitled to the best. A survey of the situation leads
to the belief that by proper organization existing facili-
ties are readily sufficient to do all the operative and lab-
oratory work required in the most efficient way. In con-
sidering this problem it must be borne in mind that, in
addition to the hospitals for returned soldiers, provision
must be made for cantonment, camp, embarkation and de-
barkation hospitals at home, and for a very large num-
ber of hospitals abroad, most thoroughly equipped with
operating facilities. There must, therefore, be a great
demand for hospital and laboratory equipment and sup-
plies which will be difficult to meet, the unnecessary du-
plication of which will place an undue burden on mechan-
ical resources already strained.
2. Hospitals for returned soldiers should be located in
centers of population — It follows from the above that
these hospitals should be established in centers of popula-
tion and where there are the best medical, industrial, and
transportation facilities; and your committee has coop-
erated with the Hospital Committee of the Council of Na-
tional Defense in advocating the establishment of general
hospitals for returned soldiers along three main trans-
continental railroad routes and in places which meet the
requirements above described. The original basis advo-
cated by the Surgeon General's department was a hos-
pital in each of the draft districts, but it was found that
there was no correspondence in the various districts with
relation either to area or to population, and it is believed
that draft districts afford no basis for the allocation of
hospitals.
3. Physicians at home should be utilized for military
service — We have advocated and still advocate some or-
ganization by which the services of physicians who must
remain at home can be made available for the care of
returned soldiers. A survey indicates that before the
war, over five thousand physicians were teaching in Class
A medical schools. Some of these have entered into active
service, but many must remain; and, in addition to these,
are men who must still remain at their posts, either on
hospital staffs or for other civilian requirements. We can
see no essential difficulty in making use of these men,
necessarily including the most skillful in the profession,
and, in addition to the skillful medical attendance thus
acquired, relieving the shortage of physicians for active
service, which will be a very serious problem unless con-
servation is used.
4. Volunteer liospital assistants should be used — We
have advocated, and still advocate, the use of volunteer
hospital assistants, more generally heretofore referred to
as nurses' aids, and in England, as V.A.D.'s.
Surveys made by various parties show clearly that the
available supply of trained nurses is not sufficient to meet
militai-y and civilian needs, and the Surgeon General's
department has recently announced that it desires to make
use of this type of service under certain conditions. These
conditions, however, are, in the opinion of the committee,
not compatible with the requirements. It is believed that
there are a large number of women of intelligence and of
suflicicnt means to offer their services as a patriotic duty,
who do not wish to enter the nursing profession as a
means of livelihood, and have no desire therefore to be
fully trained in the profession of nursing. Reports from
abroad indicate that, with an intensive training in the
service which may be required of them, women of this type
have proven most useful and entirely competent to do the
work to which they are assigned. Many hospitals have,
in anticipation of this need, inaugurated courses of train-
ing. It is believed that these courses should be stand-
ardized and that the requirements under which hospital
assistants may do their work should be duly considered,
so that there will be a thorough understanding on the part
of all concerned.
The establishment of army training schools for nurses
requires serious consideration. The difficulties of giving
a thorough nursing education during the stress of war are
obvious and, from the point of view of hospitals, methods
of supplementing the courses available in the army schools
by affiliation with civilian hospitals present problems in-
volving questions of finance, accommodation, and opportu-
nities of instruction, largely increased by the successful
efforts of many hospitals to increase their training schools
to their highest capacity. Should not these questions be
fully considered by your representatives in consultation
with the army representatives before negotiations are
made with individual hospitals?
334
THE MODERN HOSPITAL
The situation with regard to interns is still very unsat-
isfatory, especially in the small hospitals. Under the new
draft law and the educational plan of the army and the
Surgeon General's department, it may be possible to con-
trive a method which will bring some relief. Certainly
medical students should have hospital experience under
competent supervision to fit them for their army work, as
well as for the general practice of their profession, but
only such hospitals as recognize their educational duty
toward interns and see that it is performed, should
expect consideration in this regard. It will be the duty
of your War Service Committee during the coming year
to keep this important subject in mind and do what they
can to bring about the best possible adjustment.
For many years the value of industrial training for
cripples has been appreciated by hospitals in industrial
centers. Difficulties in providing proper facilities for such
training and lack of necessary funds have prevented an
adequate development of this important hospital function,
although industrial needs are far greater than those an-
ticipated for wounded soldiers. Interest inspired by the
war has hastened the development of vocational training
by many years. The Federal Board for Vocational Edu-
cation has broadened the scope of this work, and funds to
assist in such training will be available in the various
states. The work, as far as industrial cripples are con-
cerned, should, of course, be carried on in connection with
hospitals, and, while the immediate consideration is for
war work, the future should not be disregarded; and this
association should consider means of cooperating with the
Federal Vocational Board. One of the reasons for advo-
cating the distribution of military hospitals in industrial
centers is in order that the vocational work inaugurated
for crippled soldiers — necessarily of a temporary nature
and, we all hope, covering not a very extended period —
could be put on a permanent basis by using the facilities
originally provided for the industrial training of wounded
soldiers for the industrially crippled, after the war is
ended.
The War Risk Insurance Bureau is another department
of the Government which has intimate relations with civil
hospitals. It is the policy of the Surgeon General's de-
partment not to discharge soldiers until their cure is as
complete as the medical man may make it, but experience
has shown that after discharge from hospitals, there are
recurrences of old troubles, or physical difficulties result-
ing therefrom, after a considerable period, and these may
be anticipated in connection with diseases and injuries
resulting from war. Such cases must be taken care of by
civil hospitals, largely in cooperation with the War Risk
Insurance Bureau, with which many hospitals have
already established relations. The scope of these relations
should be considered and standardized by this association.
The new draft law creates new difficulties for hospitals,
both with relation to their employees and the members of
hospital staffs. As to the former, hospitals have been
placed by the War In<lustries Board in Class 1 of essen-
tial industries, so that the employees of a hospital may
be placed in the deferred list; and hospitals should claim
exemption for employees who are essential to the proper
conduct of the hospital plant. This, of course, applies to
engineers, firemen, laundrymen and others, it being under-
stood that hospitals will not take advantage of this oppor-
tunity to hold employees when their places may be filled
by women or by men incapable of military service.
With relation to the draft of physicians, it is understood
that the importance of retaining physicians on hospital
staffs and in other civilian engagements necessary to the
public welfare, is fully recognized by the authorities, and
that a plan is being considered whereby hospitals will be
properly, but not unduly, protected. In order to prepare
for this situation a circular has been sent to hospitals
requesting that rotary service on hospital staffs be done
away with so far as possible, and, as has before been sug-
gested, it is also hoped that some plan will be adopted
whereby the men who remain at home may be used for
the care of soldiers returned to this country.
Many of the propositions here touched upon will be
brought to your attention more fully during the course of
the convention. A great many patriotic people have be-
lieved that any policy adopted by the government, or any
of its departments, should not be criticised, but this com-
mittee has believed that where, after careful considera-
tion, policies either adopted or proposed were harmful or
capable of improvement, it was our duty to point out
errors and offer criticisms and suggestions, it being under-
stood, of course, that this should not be done concerning
iTiatters of fact, except with thorough knowledge of the
situation, and that, as to matters of opinion, individual
ideas should not be advanced, but that criticisms should
be based on the concurrent opinion of several authorities
competent to judge. Such fair and constructive criticism
is the foundation of democratic success.
It is therefore hoped that, as the various papers are
presented introducing these problems more directly, they
will be followed by a full and frank discussion so as to
bring about a thorough understanding of the situation,
and if it should seem expedient, definite action by vote of
the members of the association. In this connection, it
seems obvious that there is much work which may be done
by a powerful organization of hospitals with a thoroughly
competent representative always at work in the interests
of the members of the association, and that the member-
ship should be largely made up of the hospital organiza-
tions themselves rather than that the whole bur-
den should be placed upon the shoulders of their execu-
tive officers, as has been done in the past. With this in
mind, the War Service Committee joins with your Legis-
lative Committee in recommending your earnest attention
to the plan for institutional membership.
S. S. GoLDWATER, Chairman.
A. R. Warner,
D. D. Test,
R. P. Borden, Secretary.
Some Aspects of the Program of the Medical Department
of the Army and Their Effect on Civil Hospitals
By WINFORD H. smith. Colonel. M. C, U. S. A.
I am very glad of the opportunity of addressing this
association for we realize the spirit of unrest prevalent
among the authorities of the civil hospitals, due to a nat-
ural anxiety as to what the future holds for those insti-
tutions. I shall very briefly outline the progi-am of the
Medical Department, touching on some of the problems
in which I know you are most interested. It has seemed
to me that a brief presentation of the plans, devoting the
greater part of the time to discussion and the answering
of questions which you may wish to ask, would be most
satisfactory and helpful to you.
Brigadier-General Richard, the Acting Surgeon Gen-
eral, desires to extend to you his best wishes for a suc-
cessful and profitable meeting. He is deeply conscious of
the many problems which you have had to meet as a re-
sult of the war and appreciative of your splendid coopera-
tion and help whenever you have been called upon. It is
inevitable that the civil hospitals should be vitally affected
by the war program, and there is every disposition to
THE MODERN HOSPITAL
335
be as considerate of their interests as the exigencies of
war permit.
First, I wish to repeat in substance what I said to you
a year ago as the representative of the Surgeon Gen-
eral's Office. The program of the Medical Department
calls for the establishment of its own hospitals under
military control in various parts of the country and in
sufficient number to handle all of the major needs. It
has not seemed practicable to depend upon the civilian
hospitals to assist in handling the care of the large num-
bers of sick and wounded from the large camps and fi-om
ovei'-seas, for the reason that the beds of civilian hospi-
tals are likely to be needed for the civil communities,
and because it is considered impracticable and undesir-
able from a military point of view to scatter soldiers in
such small numbers as would be necessary under such
an arrangement. Your War Service Committee has not
agreed with our program in this respect, but the matter
has been given the most careful consideration, and we
are unable to see it from any other point of view.
Military hospitals will, so far as practicable, be estab-
lished in the draft districts, in order that the majority
of the sick and wounded requiring general hospital
treatm.ent may be cared for in hospitals located within
their home zone and within reasonable distance of their
friends and relatives. This plan is being, and will con-
tinue to be, modified as conditions may require. In es-
tablishing these hospitals, existing military posts are
being utilized to avoid new construction as much as pos-
sible. In addition to these posts, existing buildings such
as hotels, colleges, and, in several instances, entire hos-
pital plants, are being used. Hospital plants will be so
utilized whenever feasible. It is estimated that, over and
above some sixty thousand beds provided in the base hos-
pitals of the large camps, we shall require, not imme-
diately but within another year, approximately one hun-
dred and thirty-five thousand beds in this country. This
figure is inclusive of the general hospital beds already
established. This pi-ogram is being steadily developed
with the approval of other War Department authorities.
I know you will appreciate at once the magnitude of
the task, and I am sure you will agree with me that what
has already been accomplished in approximately one year
augurs well for the future. In that time about sixty
hospitals, averaging over one thousand patients' beds in
each, have been put into operation, over half of v/hich had
to be constructed from the ground up. This, wuth the
development of the necessary organization, statT and
.equipment, represents a considerable accomplishment for
so brief a period.
It has been my privilege to inspect many of these
hospitals, and, speaking as a civilian hospital adminis-
trator, I have no hesitancy in saying that in the main
these hospitals are doing as good work as — and often
better work than — is done in the best civilian hospitals.
This has been made possible by the experienced organ-
izers of the regular Medical Corps and the splendid re-
sponse and cooperation of the medical and nursing pro-
fessions. I am firmly of the opinion that you and the
fathers and mothers of our soldiers may rest assured that
every effort is being and will be made to afford the
wounded soldier adequate care and attention at all times.
Hand in hand with the development of the hospital
program goes that of physical reconstruction. For the
past few years the subject cf rehabilitation and reeduca-
tion of the physically handicapped has received consider-
able attention before this association, evidencing an in-
creasing appreciation that our hospital system is lacking
either in a fundamental or a cooperative factor which
would make possible a finished job in dealing with the
handicapped. The problem is not new, but more acute
because of the war. Profiting by the experience of our
allies, extensive plans are being made to meet the prob-
lem of reconstruction and reeducation of the soldier in the
best possible way. It will at once be evident to all that to
solve the problem successfully for the soldier will un-
doubtedly point the way toward, if not establish, a per-
manent basis for handling Ihe industrial cripple and the
physically handicapped generally.
The Medical Department of the Army is providing in
all of its reconstruction hospitals a system of occupa-
tional therapy sufficiently elaborate to insure proper treat-
ment to the end that the soldier may obtain complete
restoration of function, or as complete as may be possible
under the circumstances. In accomplishing this, the aim
is to conduct the treatment in such a way that, by the time
the soldier is ready for discharge from the army, he may
be turned over to the Board of Vocational Training for
final training, having gained as much as possible in that
direction by careful selection and supervision of the oc-
cupational therapy in the hospital. This is being pro-
vided for by the establishment of the shops in connection
with these hospitals and by the employment of competent
occupational teachers. An agent of the Federal Board
will also be stationed in each hospital in order that the
progress of the patient may be constantly supervised
through his period of treatment to his final vocational
training after leaving the hospital, with as little interrup-
tion as possible. This is one of the big problems to be
met, and fairly complete plans are in hand.
In order to accomplish the task before the Medical De-
partment, it is estimated that approximately forty-six
thousand physicians will be needed and at least fifty thou-
sand nurses, all in military service. About thirty thou-
sand physicians are now available or on duty, and over
seventeen thousand nurses are actually in service. You
may wonder why so many more physicians than nurses
in proportion are requii'ed. The answer is that thousands
of physicians are required in field service and in the ad-
vanced areas where nurses may not go.
You «dll ask what effect all this is to have on the civil
hospitals. The Surgeon General's Office has in every way
tried to safeguard the supply of physicians for civil hos-
pitals by the establishment of an inactive list and by its
readiness to cooperate whenever possible. It was impos-
sible for the Surgeon General to prevent a physician from
leaving his civilian post if he insisted upon entering the
service, and this has been largely responsible for the em-
barrassments which you have suffered. It is still optional
with physicians outside the draft age whether they enter
the military service or not, and it is therefore incumbent
upon local authoi-ities to persuade those who are essen-
tial to remain at home. The same applies to graduate
nurses. The public and the civil hospitals must, how-
ever, recognize the needs of the army and must be content
to run with a staff reduced to the minimum, and I think
that in the main this is fully appreciated.
There has apparently been some confusion and misun-
derstanding concerning the physicians' Volunteer
Service Corps and its relation to the Medical Corps and
the Medical Reserve Corps. This organization has been
developed under the auspices of the Medical Section of
the Council of National Defense, and should in no wise
be conf.i ed with the Medical Corps or the Reserve Corps.
Strictly speaking, it is not a Government oi-ganization.
In some localities physicians have obtained the impression
that they must either join the Volunteer Service Corps
or the Medical Reserve Corps. This has resulted in the
336
THE MODERN HOSPITAL
filing of many applications for commission by those who
are not in a position to accept service. The Surgeon Gen-
eral does not wish anyone to apply until he is ready to
accept active service. As a matter of fact, any physician
now granted a commission will be obliged to accept active
service almost immediately.
It is appreciated that, by changing the draft age to
18 to 45, many new problems have arisen or old problems
have become more acute, such as the continued supply of
interns and staff physicians and, what is quite as im-
portant, the supply of employees. Having this in mind.
General Richard, Acting Surgeon-General, recently ad-
dressed a communication to the Provost Marshal General
requesting that hospitals be placed in the class of essen-
tial industries and that members of the professional and
administrative staffs be considered eligible for exemption,
and that the draft boards be so notified. The Provost
Marshal General has replied to this request with ap-
proval and with the statement that a bulletin has already
been issued to the draft boards which so classifies hos-
pitals and places it within the jurisdiction of the district
boards to recognize for exemption those who are con-
sidered essential in hospital work. This bulletin reads as
follows :
"The necessity of not seriously interfering with cer-
tain occupations and employments, such as financial, com-
mercial, educational, hospital work, care of the public
health, or with the conduct of certain other activities nec-
essary to the public welfare and the prosecution of the
war, "requires that the District Boards have the coopera-
tion of such advisers, so that persons necessary in such
activities be not removed therefrom."
This apparently applies to both professional and em-
ployee classes and should do much to clarify and ease the
situation for civil hospitals. The needs of the army must,
however, be constantly borne in mind, particularly with
relation to physicians and nurses.
I have ah-eady said that the army will require at least
fifty thousand nurses by this time next year. It is of
course impossible to obtain this number of graduates;
therefore, measures have been taken to supplement the
supply of graduates by pupils of the Army School of
Nursing and by hospital assistants. It is believed that
the plans being developed will prove adequate; if not,
they will be modified whenever it becomes necessary. I
will not dwell longer on this subject at this time, for this
will be dealt with in detail at the special session this
evening for the discussion of nursing problems. This
point, however, should he emphasized — that the Surgeon
General has been mindful of the need of interfering as
little as possible with the existing schools of nursing in
civil hospitals and has adopted the present plans as
guaranteeing the least interference with those schools.
One other problem now presents itself as the result of
militarizing universities and colleges including medical
schools. This is in no way a discussion of the wisdom
of such a step, but is merely intended to answer some of
the questions which arc being asked and which you are
sure to raise.
If the medical schools are militarized and all students
drafted into the service, where are the civil hospitals to
obtain interns a year hence, and how can men be re-
tained for the resident or upper staffs? These questions
are now under consideration, and it is to be expected that
satisfactory answers will be found. At present it appears
that only those who are physically disqualified and women
physicians will be eligible for staff appointments for a
period longer than one year. As for the supply of in-
terns, while no definite decision has yet been reached, it
is expected that medical graduates will be allowed one
year's internship before taking commissions. The ques-
tion will naturally be asked, "Is the internship or the
commission to be left to the choice of the individual?"
This question will be prompted by the feeling that if it
is optional very few men having had a year of service
in military life will choose internships in civil hospitals.
This is undoubtedly a vital question to the hospitals.
At present the disposition of the Surgeon General is
toward making the intern year a requisite for commis-
sion. If this is established, the supply of interns will be
assured. No decision has yet been made, however.
While students, the men will be furnished free tuition,
maintenance, uniforms and the pay of a private, accord-
ing to the present plans of the War Department. What
will be their status as interns? It is impossible to answer
that question definitely at this time. It is probable, how-
ever, that they will either continue as enlisted men in
service under training, and continue to draw the pri-
vate's pay, or that the hospitals will be expected to pay
the intern instead of the Government, the period of in-
ternship being considered as an indefinite furlough. Both
of these methods are under consideration. In any event
it appears that measures will be taken to safeguard the
supply of interns, which, from your point of view, is the
vital question. As an indication of the attitude of the
Surgeon General's Office in safeguarding the civil hos-
pitals, may I point out, of the 2,300 graduates of the
class of 1918, 1,200 have been definitely authorized by
the Surgeon General's Office to remain on inactive duty
for one year intern appointments? Only sixty-five of the
2, .300 graduates are on duty in the army and 193 in the
navy, according to the figures furnished me. There are
28.5 enlisted privates of the Medical Enlisted Reserve
Corps who have not yet applied for inactive duty for in-
tern appointments, which is partly the fault of the in-
terns and partly the fault of the hospital in not using
every effort to see that their interns are authorized to con-
tinue on inactive duty. Every intern and every 1918
graduate has been advised that the regulations practi-
cally require him to have a one year hospital service be-
fore he can expect a commission. At the least, nineteen
hundred of this year's graduates are interns in hospitals,
which is probably as lai'ge a proportion as in any previous
year. These are the figures furnished me by the divi-
sion of the Surgeon General's Office, charged with the
responsibility of handling the intern and medical student
problems.
The Nursing Program of the American Red Cross
By jane a. DELANO, director Department of Nursing, American
Red Cross
The Red Cross organizations of the world developed
primarily out of the need of nursing care for the sick and
wounded of armies. Two important factors leading to the
development of the Red Cross organizations were the
work of Florence Nightingale in the Crimea and the neg-
lect of the sick and wounded after the battle of Solferinc.
That nursing the sick and wounded of armies was recog-
nized primarily as one of the chief functions of the Red
Cross, is shown by the fact that providing such nurses
was mentioned in three of the six articles of the Red Cross
Geneva treaty, dealing with the subject of nursing per-
sonnel.
The responsibility for the development of a nursing
service was accepted in the reorganization of our own
Red Cross in 1905 as one of its functions. It was further
believed that such service should be definitely related to
the needs of the army and navy. At the request of the
Surgeon General of the Army, in 1909, the Red Cross un-
THE MODERN HOSPITAL
337
dertook plans for the expansion of the service and its
adaptation to the needs of the army. So important was
this relation believed to be, that regulations were issued
by the Secretary of War making the Red Cross Nursing
Service the reserve of the Army Nurse Corps, provided by
law, and a proclamation issued by the President of the
United States at about the same time placed upon the
American Red Cross the responsibility of acting as a re-
lief agency to the army and navy in time of war.
As the charter of the American Red Cross authorized
the administration of relief in time of peace, enrolled
nurses of the Red Cross were at once utilized for this
work, and have been freely called into service during the
past nine years. Not only was this helpful to the civilian
population, but gave an opportunity for practical experi-
ence in meeting unusual conditions, and greatly strength-
ened the allegiance of the nurses of the country to the
.•American Red Cross.
When war clouds threatened between this country and
Mexico in 1914, the Red Cross was called upon during the
occupation of Vera Cruz by our troops, and remained there
until they were withdrawn. This was their first service
under war conditions. With the mobilization of the troops
on the Mexican border, an increased number of Red Cross
nurses was called upon for service as a reserve to the
Army Nurse Corps. The number of Red Cross nurses as-
signed to duty steadily increased with the increase in the
number of troops on boi'der duty.
From the first assignment of nurses to duty in Vera
Cruz, April 21, 1914, to our own entrance into the war in
April, 1917, our Red Cross nurses were continuously on
duty with the military forces. With the declaration of
the European war in August, 1914, the American Red
Cross promptly offered the services of physicians and
nurses to each of the European countries involved, and by
September 1, 126 nurses were mobilized in New York and
ready to sail. Other units quickly followed, and during the
first year of the war we had nurses continually on duty in
England, France, Germany, Austria, Russia, Servia, and
Bulgaria- These units wei-e later withdrawn (October 1,
1915), but many of the nurses volunteered to remain,
and we had many Red Cross nurses as volunteers in all of
the allied countries until our own entrance into the war.
The experience of the Red Cross in Europe during the
first year of the war convinced us that units would be
more efficient if made up of physicians and nurses from
the same school or hospital, and in the early spring of
191.5 the Red Cross, with the approval of the Surgeons
General of the Army and Navy, undertook the develop-
ment of hospital units along these lines. Twenty-five of
the leading hospitals of the country were asked to co-
operate in the developing of these units and the securing
of the necessary equipment for them. Definite instruc-
tions concerning the nursing personnel of these units were
sent to each of the chief nurses in order that a well-bal-
anced group might be selected, sufficient to meet the needs
of a general hospital. The following list was taken as a
guide in making selections for service: Each hospital
unit was to have one chief nurse, one assistant chief
nurse, one night chief nurse, one charge nurse (operating
room), five assistant nurses (operating room), one charge
nurse for dietitian, one charge nurse (linen room), thirty-
eight medical and surgical ward nurses (twenty-eight
day and ten night), fifteen reserve nurses (not on roll),
four diet kitchen nurses' aids, four linen room nurses'
aids, two nurses' aids for nurses' quarters, fifteen nurses'
aids for wards, and twenty-five reserve nurses' aids. All
nurses' aids must be members of the Red Cross.
Three of the nurses were supposed to have had some
practical experience in the care of contagious diseases.
This plan was adopted, not only to provide a well-bal-
anced group of nurses for possible military service, but to
prevent the withdrawal of too many executives and spe-
cialists from the civilian hospitals.
Because of our organization for two years previous to
the war, during the entire year of 1916 we had a long
waiting list of nurses willing to accept service here or
abroad.
When war was declared in April, 1917, the Red Cross
had forty-six base hospital units authorized, and twenty-
five were well under way. Seventeen units were assigned
to foreign service with a nursing personnel of 1,390, and
four additional units were ready, waiting orders to sail,
w-ith a nursing personnel of 260, between June, 1917, and
January, 1918. In addition to the personnel which had
been secured, approximately between $25,000 and $.S5,000
had been collected for the equipment of each unit. Later,
it was found that the equipment of base hospital units
would cost between $40,000 and $50,000, all of which was
I'aised by volunteer subscription.
In the development of these units, it was thought prob-
able that they would be used with the army on the Mex-
ican border. With the movement of our troops to France,
however, the plan to utilize these units was abandoned,
and several of the base hospital units were sent immedi-
ately abroad. As we had relied upon these units for serv-
ice in this country, this change of plan led to the organiza-
tion of emergency detachments to be used in our own can-
tonments.
With the sudden outbreak of contagious diseases in the
cantonment hospitals during the winter of 1917-18, a
greatly increased number of nurses was needed at home,
and, as several thousand w-ere holding themselves avail-
able for sei'vice in connection with the base hospital units,
it was difficult to convince the nurses of the country that
any great need existed, as those already prepared were
not being called upon for service. While we believed that
unit organization would give the most efficient service,
we changed to the selection of individual nurses for as-
signment as the best way of meeting the emergency de-
mands from the Surgeon General's office, and this plan of
selection was put into immediate operation.
A tremendous burden has been placed upon the Nursing
Service of the Red Cross and the nursing profession of
.\merica during the past four years, and I believe it is not
too much to say that the continuous needs of the army
have been met at the sacrifice of personal interest and
personal desires, and that the nurses of America have re-
sponded nobly. Never before in the history of nursing
lias it been attempted to man large hospitals varying in
size fi-om several hundred to several thousand beds with a
graduate sei'vice of nurses. Nor is it believed that even in
time of war this is the best form of hospital administra-
tion. It is hoped that the Army School of Nursing will
supply the greatly needed supplementary service.
The Red Cross realizes, however, that, as a resei-ve to
the army and navy, it is their responsibility to secure
promptly and in sufficient numbers the nursing personnel
requested by the Surgeon General.
The Red Cross Nursing Service does not exist solely as
a reserve for the Army and Navy Nurse Corps, but main-
tains a permanent nursing service available in peace as
well as in war. When assigned to duty as a reserve to
the Army and Navy Nurse Corps they become tempo-
rarily a part of it; but when released they are again avail-
able for assignment. It is this permanent relation to the
338
THE MODERN HOSPITAL
Red Cross which has kept it apart from the more tempo-
rary war services, and as such, is has made a very direct
and compelling appeal to the nursing profession of the
country. With the increasing number of nurses in active
service it became evident that the nursing resources of
the country must in every way be conserved. In order
that assignments might be made to the best possible ad-
vantage, arrangements were made with the Surgeon Gen-
eral of the Federal Public Health Service, in the spring of
this year, to take over the selection of nurses under that
service, in order that there might be no unnecessary over-
lapping and that the various services and the applications
of all nurses should receive equal consideration. This
Federal Public Health Service includes all marine hospi-
tals, the base hospitals established for the munition work-
ers at Nitro, West Virginia, "Public Health Service in the
sanitary zones surrounding the cantonments, and nurses
assigned to contagious work at the request of the Federal
Public Health Service.
The Red Cross also maintains under its own auspices in
Europe groups of nurses in Italy, Russia, Servia, Rou-
mania, England, and Greece, and is supplementing the
services of these nurses with specially prepared nurses'
aids, who act as interpreters and assist in the hospitals or-
ganized under the American Red Cross and the French
government. They are also assisting in the infant wel-
fare work and in the care of refugees abi-oad.
In addition to the definite war service, the Red Cross
maintains a permanent Public Health Nursing program
and has nearly one hundred Red Cross nurses serving in
town and rural communities as members of its Town and
Country Nursing Service. It is hoped to expand the work
greatly to help meet the conditions incident to war.
We are conducting through our Red Cross chapters va-
rious courses of instruction for women, intended primarily
to give the simple principles of personal and household
hygiene, to prevent contagion and lessen disease. A large
number of women, in fact over sixty thousand, have al-
ready received instruction in elementary hygiene and
home care of the sick under the auspices of the Red
Cross,, and we expect to extend the scope of this work
during the coming year. It is believed, by such authori-
ties as Miss Julia Lathrop, of the Children's Bureau, that,
if we are to meet war conditions in the best possible way,
women must be prepared to occupy the same relations to
their families as they held during the period previous to
the use of hospitals and graduate nurses — in other words,
that women must be taught to maintain, as far as pos-
sible, the health of their households, and to care for
minor illnesses in their own homes, in order that commu-
nities may be safeguarded and a reasonable number of
nurses released for military service.
Under the Department of Nursing, a Bureau of Dieti-
tian Service is also conducted, which has enrolled during
the past two years over 1,620 dietitians, and has assigned
about three hundred to active service, either in military
hospitals, at home or abroad, or directly under the aus-
pices of the Red Cross. Most of the remaining enrollment
are listed in division offices as instructors. Courses of in-
struction are also directed under this bureau in home
dietetics, emergency cooking and war diet in the home,
once more aiming to fit the women to care for their fam-
ilies and to cooperate in the relief work brought about by
the needs of the war.
In order that all of the nursing resources of the
country might be available for the service for which
they were needed and best qualified, the Red Cross
has authorized three classes of enrollment — enroll-
ment for active service, consisting of those nurses sup-
posed to be available for military duty; home defense
nurses, who are unable to respond to call for active serv-
ice but might be able to give all, or part, of their time to
their own communities, such as married nurses, or those
who are physically disqualified; special service enrollment,
consisting of nurses holding important positions who
should not at this time be withdrawn for military service.
It is believed that practically every graduate nurse in the
United States can be listed in one of these three services
and made available for service under the direction of the
Red Cross or the Army and Navy Nurse Corps.
Our total enrollment at the beginning of the war, April
7, 1917, was 8,015. This represented the total enrollment
of nurses from the beginning of the reorganization of the
Red Cross in 190.5 to that date, and included nurses en-
rolled for special service, such as committee work and in-
structors in home care of the sick, and others who were
not available for active service, either on account of age
or other conditions. An eifort was promptly made to
stimulate enrollment, and increase the number of avail-
able nurses. This was done largely through the develop-
ment of units, upon which we relied for sei'vice. Our total
enrollment to date is something over twenty-eight thou-
sand, but, as our enrollments are numbered consecutively,
this also represents a proportion of nurses who are not
available for active duty. The number varies, but a com-
plete record is kept at Red Cross Headquarters of the ex-
act status of the entire enrollment. To Sept. 1, 1918.
there has been assigned to duty to the army 15,174; to
the navy, 997; and to the Federal Public Health Service
and directly under the auspices of the American Red
Cross, 624. Approximately one-half of these nurses are
serving in Europe, and one-half in the United States.
A definite campaign to secure twenty-five thousand
nurses for service by January 1st was undertaken by the
Red Cross in June of this year. An allotment was made
to each state on the basis of the number of nurses in each
state and the number already withdrawn for service. As
a result of this special effort to secure nurses, 1,571 were
enrolled in June, 2,668 in July and 2,680 in August. If
we are to meet the needs of the Surgeon General's office
between now and January 1, it will be necessary for the
Red Cross to enroll approximately ten thousand additional
nurses.
In addition to the units organized for general hospital
service, we have selected for service with the Army Nurse
Corps, a group of sixty-five psychiatric nurses for a spe-
cial hospital in France. Every member of this unit had
had unusual experience in the care of the insane and the
various phases of the work. We have selected special
groups of nurses for infant welfare work. We have aided
in securing the personnel for a large fracture hospital,
also for orthopedic service, for head and neck surgery, and
have now in Europe serving under the Red Cross nurses
especially qualified in public health work, infant welfare
work, and in educational work to act as instructors to na-
tive women to prepare them as assistants in war service.
We have a large number of French and Italian women re-
ceiving such instruction from nurses especially qualified
for this service.
In i-eviewing the work of the nurses of America, we
have faith to believe that they will continue to respond to
the needs of their country, and to cooperate with the Red
Cross in supplying the nurses required to care for our sick
and wounded in France, and in the cantonment hospitals in
this country. They will not, I feel sure, want to be
"among those missing," when the roll of honor is called
after war is over.
THE MODERN HOSPITAL
339
The Relation of the War Program to Nursing in Civil
Hospitals
By ADELAIDE NUTTINi;, chaiiman Committm- on Nuising. Gen-
eral Medical Board, Council of National Defense.
Defense.
As soon as we had entered the war, it seemed clear in
the very nature of things that there would be problems to
meet which would not fall within the province of any
existing body to handle. The Army and Navy Nurse
Corps had well defined tasks and would, of necessity,
move in their own prescribed orbits. The Nursing De-
partment of the Red Cross had many activities, but, as
the great recruiting agency, it would be largely occupied
with the colossal problem of keeping up the nursing re-
serves. These could proclaim their needs and they were
paramount, but there should be, it seemed, some other
body constantly at work to help in finding ways of meet-
ing them, to forwai'd and supplement their efforts and
also to look to the nursing needs of the civil population.
Such a body would be concerned with the care of the sick
in civil hospitals and homes, with the problems of train-
ing schools for nurses, and with such emergencies in nurs-
ing as might from time to time arise during the progress
of the war. It was further realized that new problems in
nursing must inevitably follow the war and that careful
and serious study in preparation for them should begin at
once. Hence, there was formed an Emergency Committee
of Nurses (and others), which later became the Commit-
tee on Nursing of the General Medical Board, Council of
National Defense.
I assume that I am asked to speak here tonight of the
relation of the war program to nursing in civil hospitals,
because it is to that particular problem that the Commit-
tee on Nursing has since June, 1917, devoted the larger
part of its time, thought, and resources. As chairman of
that committee, whatever I have to say must necessarily
be drawn from its activities and experiences.
What the w-ar really was going to mean to our hospital
training schools did not, I am confident, come home with
any great force to most of us until we saw the fii'st base
hospital units sail for France and realized how, in a mo-
ment, there had been swept out of our educational struc-
ture, never strong enough for its work, superintendents,
assistants, super-visors, instructors and head nurses, and,
in some instances, several of those oiRcers from one hos-
pital school. Public Health nurses, too, so few in number,
were drawn into the tide that flowed to the military hos-
pitals in France. Well pi-epared as we believed ourselves
to be to meet the first call of the war, and eager as we
\vere to meet it, this depletion of the i-anks of our execu-
tive and teaching body was a revelation. It brought home
to us the necessity of taking immediate measures to find
and train more women to fill these difficult and responsible
fields, and our appeal to the colleges was the outcome. It
seemed i-easonable to expect that our colleges should sup-
ply at least a portion of such candidates and that the col-
lege women bringing a sound groundwork in education
could more readily grasp the underlying principles of the
work and could proceed more rapidly with their training
than less prepared students. Moreover, they would bring
a larger degree of maturity.
Having secured assurances fi-om several leading train-
ing schools that an appreciable reduction in the course of
instruction could be made to college women of suitable
qualifications, we wrote, explaining the nursing situation
and appealing for cooperation to the authorities of every
woman's college and all the standard coeducational col-
leges in the country, and also to many thousands of their
graduates. The result has been that for over a year, col-
lege women in constantly increasing numbers have been
entering our schools of nursing, and this last summer wit-
nessed a striking phase of the effect of our efforts in the
Vassar Training Camp for Nurses. For, without all of
the previous work there could have been no Vassar Camp,
and the more than four hundred splendidly prepared and
enthusiastic young college graduates who are at this time
entei-ing many of our representative schools of nursing
would have been entering some other field of service.
Vassar is not the only college which has helped to
meet the nursing problem. This summer the Western Re-
serve University at Cleveland, and the Universities of
California and Iowa offered the preliminary scientific
courses required in the training of nurses to several hun-
dred students all told, I understand; and the hospital
training schools to which these students are now going
have thus been relieved of the expense and trouble of
teaching and maintaining them for this preliminary
period.
The next step recently taken forges another link in the
chain of cooperation by which we have been trying to
unite the higher educational institutions and our hospital
training schools. The influence of the Vassar experiment
has enabled us to work toward plans through which a
large number of selected colleges and universities are now
being asked by the American Council of Education to
establish pre-nursing courses as a war measure. The cir-
cular recently issued from which I quote says these will
be for the "purpose of assisting civilian and army hospital
training schools to meet the ovei-whelming demand for
adequately trained nurses." These pre-nursing eoui'ses
should serve to prepare successive groups of young women
in various communities all over the country for entrance
to hospital training schools and for immediate usefulness
after they do enter and it is expected that several thou-
sand students will seek this preparation. Thus the pres-
sure on hospital training schools which has been increas-
ingly heavy because of the need of training large classes
with smaller teaching staff, may be in a considerable
measure lifted.
I have dwelt at some length on our work in connection
with colleges, but not because of its dimensions. The
numbers of nurses with which it is concerned will be com-
paratively small, (though superlatively important), but
because it shows a steady persistent effort extending over
sixteen months to align the colleges beside us in working
toward the solution of some of our most urgent problems.
We have at least made certain that, for the higher and
more exacting forms of nursing, for the direction and de-
velopment of our training schools for the instruction and
training of futm-e nurses, for the guidance of the work-
ers in the many fields of public health nursing, there will
ultimately be available many hundreds of well-trained
nurses who have also had the advantages of full college
preparation.
Having provided as well as we could for the line and
staff, our next step was to build up the working force.
The needs of the army for nurses were for the
time being met, and the immediate future was pro-
vided for; but behind that there stretched away a period,
and it might be a long one — no one could tell — for which
no adequate provision existed. Predictions of the possible
demand for nurses dealt in large terms and increased
from month to month. The steady expansion of our army
made necessary the great development of military hos-
pitals ai. iiome as well as abroad, and the call was not only
for proper nursing service during the war, but it pointed
clearly to enormous demands for nurses in the greater
work of reconstruction which would inevitably follow such
340
THE MODERN HOSPITAL
expansion. These demands, it seemed, would extend into
civil hospitals and would penetrate every form of public
health work. For we knew that in the forefront of the
great questions which the war at its close will press upon
us, which it is even now pressing upon us, stands the ques-
tion of health, and the part which trained nurses must
fill in this field is too important and fundamental to per-
mit us to forget it, or to neglect to prepare them for it in
large numbers. We realized, further, that those nurses
who had gone into army service might not return for a
long time, and a good many would not return at all. Their
places would have to be filled.
But there was another question before us. When the
needs of the army could no longer be met by graduate
nurses, where should we turn? And a few of us at least
believed that the very best body in which to reinforce the
graduate nurses would be found in the senior classes in
our schools of nursing. As approximately fourteen thou-
sand nurses are now graduated every year, that number of
senior nurses, young women with at least two full years of
training behind them, would be there to draw from; and
that these young women were capable of giving excellent
nursing service would not admit of question. In estimat-
ing the potential nursing resources of the country, there-
fore, we have never overlooked this possible supply, and
that it should be turned to when necessary was our rec-
ommendation to the special committee convened in June,
1917, by the Red Cross. We felt that a certain quota
could be asked for, and would readily be released by the
hospitals if they were in any position to do so. And then
we proceeded to try to put them in a position to do it.
We started well over a year ago a comprehensive and
widespread campaign of educational publicity. In it we
tried to tell people something about nursing and hospitals
and public health, to show young women and their par-
ents just how indispensable a field of human effort nursing
must always be, and how in great crises like the present
it becomes an essential part of national service. We tried
to show that the life of the nurse is not only one of sur-
passing usefulness, but of much personal happiness and
satisfaction, and that great fields of public importance
were now opening up to her in many directions. We
urged every hesitating young woman who, seeking a field
of useful activity, faltered at the door of the hospital
training school, fearing she knew not what difficulties and
severities, to put aside her doubts, to enter and to try to
prepare for the service the country most needed, and at
the same time to give the hospitals the service they con-
stantly require and for which they must at present depend
in large measure upon student nurses. Such appeals were
sent forth in many thousands in every state in the coun-
try, supplemented by requests to high and private schools
to bring the matter before the older students and alum-
nae. Articles on nursing were published in the daily press
and in popular periodicals, addresses were made in
schools, churches, and at special meetings. From our of-
fice in Washington, a constant stream of advice and in-
formation on this subject has poured forth to thousands of
inquirers.
As a result, we could point in April to reports coming
from between seven hundred and eight hundred training
schools (about half of the number of hospital training
schools on our lists), which showed that over seven thou-
sand students over and above the usual number had
been admitted during the year. As the recruiting has
been going on steadily, it seems likely that this number
has been somewhat increased in the intervening months.
A study of the reports, however, showed us that, while
the larger and better equipped hospital training schools
had in most instances a considerable increase in the num-
ber of students, there were still a good many hospitals,
particularly the smaller ones, which were without appli-
cants and greatly in need of students to carry on their
work, for which little other assistance could be provided.
It seemed necessary to devise some way of taking care
of them. It was apparent also from the increasing de-
mands for nurses for the army that efforts to keep our
training schools full in oi-der to replace the nurses called
away must not slacken. And at this time the establish-
ment of the Army School of Nursing with its great
scheme of student service called for large and immediate
i-ecruiting efforts. A new and interesting plan for re-
cruiting was worked out by the Women's Committee of
the Council of National Defense, from whom we had pre-
viously had much helpful cooperation, in conjunction with
the Red Cross and the State Councils' Section, and under
the direction of the former a campaign was inaugui-ated
to build up what was termed The United States Student
Nurse Reserve and to enroll in it, as applicants to meet
the needs of both civil and army schools of nursing, many
thousands of well qualified young women. This campaign
has been vigorously carried on by the Women's Commit-
tee, through its twelve thousand committees throughout
the states and with valuable help from the Red Cross, and
the reports yesterday showed that 10,458 applicants had
ah'eady been enrolled, of whom 3,358 were eligible for the
Army School of Nursing and 5,982 for civil training
schools. Of these, 2,134 have to date been assigned to
hospital training schools which have vacancies and need
students, and the assignment is going on rapidly. This
does not tell the whole story, for there are other recruit-
ing efforts which have been can-ied on somewhat inde-
pendently; in the City of New York, for instance, about
one thousand seven hundred additional applicants have
been referred during the last few months, through the
Bureau of Information of the Red Cross, either to the
army or to civil schools of nursing.
How the plan is woi-king out can, perhaps, be shown by
the following typical letter which comes from the super-
intendent of a hospital in sore straits for student nurses:
"On behalf of the Board of Managers of I wish to
thank you sincerely for your attention to the matter of
assignment of nurses to this institution.
"The names, addresses and credentials of twenty-four
members of the United States Student Nurse Reserve
have been received, and I am hastening to communicate
with them in order that they may report for duty without
delay.
"The hospital will endeavor to do its part by giving a
thorough and effective training to the young women whose
nursing education has been entrusted to its care in this
great crisis.
"The question of affiliating with the Army School of
Nursing is now under advisement and will receive the
early and careful consideration of our Board.
"Thanking you again for your help at this time when
the help was most needed, I am,
Sincei-ely yours, "
In several instances nurse applicants who had been re-
ferred to training schools which were needing students a
few weeks ago found the vacancies already filled through
the local interest aroused.
From the outlook as it now stands, I think we can count
upon such a substantial increment to the body of student
nurses in our hundreds of hospital training schools as
will enable them to take care of the sick in their respect-
ive communities and later will enable them to release
some of their older students for army service if the
country needs them. There will undoubtedly, however,
be some institutions which we can find no way of helping.
Possibly the help they need must come first from within.
THE MODERN HOSPITAL
341
Our latest effort to help the training schools of our
civil hospitals has led us to appeal to the Federal Board
of Vocational Education to extend to schools of nursing
some of the benefits it so freely accords other branches
of vocational work. This will mean that in a good many
schools teachers may be supplied free of expense for
certain subjects such as elementary science, dietetics,
nutrition, hygiene, etc. This should prove particularly
helpful to hospitals in small towns, where it is often diffi-
cult to find a good teaching staff. It may be that this
will ultimately prove to be the most permanently useful
and far reaching thing we have done. It is a great satis-
faction and relief to know that many training schools
which in the early days of war had few applicants (some
of whom were even then dropping from the accepted lists
to take the short and easy path provided for "aids") are
now facing the winter's work with schools filled to over-
flowing with the best qualified students they have ever
had. Instead of being broken down by the competition of
short courses, of the many new occupations for women
which have arisen during the war, and of the great in-
crease in demands for women in their old familiar occu-
pations, our schools of nursing have been held up, forti-
fied and strengthened. The majority of them are now
working at a high level of productive activity and are,
or soon will be, in a position to offer some quota of their
senior nurses if the country needs them.
I cannot help feeling that one of the best results
of our year's work to interest young women in nursing
has been a better understanding by the public, not only
of the importance of nursing and the extraordinary op-
portunity for usefulness which it offers, but of the prob-
lems which ti'aining schools have to meet, and of the
difficulties which hospitals often labor under in trying to
maintain good training schools. I am sure this educa-
tional campaign of ours will bear fruit for years to come.
There will not be so much difficulty getting good appli-
cants. There will be made available in the future for our
hospitals' and training schools much valuable help and
cooperation on the part of the community.
It has been very interesting indeed to see the change
in attitude which has come about during the past year.
At first almost everybody wanted to take a few weeks'
course and go to France at once. Now many young
women are realizing that they can do nothing that is
worth while without some real serious training and hard
work, and they are willing to take almost any training
that is prescribed by those in authority. There is a de-
cided reaction going on against short superficial courses
of training. What the majority of young women seem
to want to do now is to "make good" and to do what their
country most needs of them. This seems evident fi-om the
hundreds (I might say thousands) of interviews which
woi-kers all over the country have had with the girls and
women who are volunteering for the nursing service. We
have only ourselves to blame if we fail to make the best
use of all the excellent material which is coming to us —
literally placing itself in our hands. The amazing record
of enrollments already in the Army School of Nursing
shows how true is the present response to this kind of
an appeal. This school is the embodiment of a great idea,
and its plans are being worked out in a statesmanlike
way. In its own sphere it falls in line with the feats
in shipbuilding and with the scheme which finds a way
of hurrying a million troops across the Atlantic in a few
months. To organize thirty or forty or more training
schools in swift succession and to bring in a few months
thousands of highly qualified young women into serious
training for the service of the country is an achieve-
ment. The Army School can provide our main future
supply of nurses for the army, and it should have our
fullest cooperation and support.
So far I have tried to show how war has affected nurs-
ing in our civil hospitals. Its future eft'ect we cannot
altogether foresee, but changes are foreshadowed, and
some of them are already taking place. It is evident that
the three years of training, if it is to remain, must serve
to prepare nurses for a wider service than it has hitherto
included. Whatever may have been the demands of the
past in nursing to which the training schools have tried
to respond, the needs of the future will make new con-
siderations inevitable. In the slow and painful readjust-
ment which is before us when we cease the industries cf
war and resume the activities of peace, we must give new-
kinds of care and pi-otection to the health of our people.
The program laid down by the British Labor Party will
probably be in a measure our own program, and it in-
cludes a Ministry of Health, the safeguarding of mother-
hood and infancy from privation, and adequate public
provision for the reduction of sickness and injury to a
minimum by prevention and proper ti'eatment. Definite
instruction for nurses in the subjects most vital to public
health and careful training in the problems with which
the public health nurse must inevitably deal, are there-
fore now clearly called for. Whether she works in the
homes among young mothers and infants, in the schools
among school children, in the factories among young
girls or any employees who need advice, guidance or
actual service, the nurse has become for the future the
prototype of the one to whom we must increasingly turn
to help maintain our home and health defenses. If we
must turn to her, we must train her; and, whatever comes
later after her hospital training, the groundwork must be
laid in the training school, and the process must be as
sympathetically and intelligently conducted as we know
how to make it. And because the need is with us, strid-
ing beside the need of the army and keeping pace with
it, we must be at work upon that problem voir. We must
eliminate the great waste of women's effort that goes on
in many of our hospitals, reduce the amount of unskilled
and unnecessary labor so frequently a routine part of the
training of our student nurses, enlarge the amount of
sound and substantial knovviedge now required and pro-
vide nurses with a wider outlook upon life's real problems.
It is probable that an earlier and larger place in the
scheme of training must be given to the care of infants
and young children and obstetrics. It seems certain that
more thorough and comprehensive teaching in the sub-
ject of communicable diseases is called for and that some
acquaintance with mental diseases is certainly most im-
portant. A training which covers three calendar years
should include these matters if it is to render its full
measure of usefulness to society.
The war program in relation to nursing in civil hos-
pitals must go, therefore, far beyond efforts to maintain
in them an ample and efficient service during the vicissi-
tudes of the war. It must go beyond enlargements of
the schools by continuous influx of students to form the
nursing reserves of the army later. It must take into
consideration the new needs in nursing which the war
will impose upon us — its terrible aftermath — and with
these our training schools are deeply and vitally con-
cei'ned.
The civil hospital schools have for months been mak-
ing their best effort to meet the great emergency. Now
the Army School has been called into existence to work
not in competition with them, but as a new ally. And
an alliance calls for understanding and effort on both
342
THE MODERN HOSPITAL
sides. We have, for instance, sent our million men to
fight in France but we have depended upon the ships of
our British allies to carry 60 per cent of them. The
Army School will add greatly to the sum total of nurses
who will be in training, will form a large part of our
reserve power and will be ready before many months to
reinforce the regulars wherever needed. And further-
more, the call of the Army School will be listened to by
many of those young women whose understanding of life
has not yet reached the Heights which would enable them
to see that our civil hospitals offer the same perpetual
challenge to young womanhood for the service of the
nation as do the army hospitals in war time. For in
times of peace the student nurses in any hospital are
working in some of the world's most ancient and as yet
unconquered battlefields.
I think our civil hospitals may well be proud of their
training schools. Any institutions which meet the crises
of life as well and as nobly as our schools of nursing on
the whole do, must stand among our cherished institu-
tions and should be a matter of national pride. Their
contribution to the country in this hour is whole-souled,
genuine and dependable. As a recent observer in France
says, "The American nurses are 100 per cent efficient."
"The nursing is admirable," says another, "good, solid,
skilled work." Colonel Finney, in discussing the situa-
tion with me recently, said that the country could well
be proud of its army nursing sei-vice and of the quality
of its work. He spoke particularly of the movable hos-
pitals which follow the troops, and are so near the scene
of action that nurses are and will continue to be under fire.
This service he says is voluntary. But they all volun-
teer. There is no difficulty in getting them to go any-
where, no matter what is to be done. Thus far, there-
fore, our nurses have shown a high spirit of devotion and
sacrifice. They have given unstinted labor and have
nerved themselves to their great tasks, have heroically
worked and heroically died. It is for us in whatever
ways are fitting to pay our tribute to such women, and to
help them keep up their fine morale.
May I venture here to pay a brief word of tribute to
the women at the head of our training schools? Some
of the hardest sacrifices that have been made during the
war have been made by these women working- stead-
fastly at their posts, away from the public eye, tryine;
gallantly to meet the new and continuous demands which
the war has brought. They are bearing the burden and
the heat of the day, and they deserve the fullest possibl'j
support from their hospital authorities and the public in
the truly patriotic efi'orts they are making.
And may I say finally a word of the whole nursing
situation and of those who have been struggling with its
problems? War and its challenges are new to us, and
most of us are not warriors. But our devotion to the best
interests of the sick, whether under our care in military
or civilian hospitals or in homes of any kind is, I know,
single-minded and sincere. We have wanted them to
have the best nursing care which we are capable of giving,
and every step we have taken has been with that purpose
and that hope in mind.
Social Service and Hospital EHicicncy
Bv A. R. WARNER. M.D., superintendent Lakeside Hospital.
Cleveland, Ohio,
We are all quite familiar with the word "efficiency,"
especially in its use to express the existence of an organ-
ization or process to secure maximum results through the
expenditure of minimum time and effort. But what are
the ideal maximum results of a hospital's existence and
activity? This must be established in order to determine
the essentials of the best organization or process, or its
efficiency. Of late the ideas about thorough, complete
hospital work or results are changing quite decidedly and
very rapidly, although this change has been marked in
various ways and tempered by various viewpoints.
A single fundamental force, or a development of an idea
or social principle, has caused extensive progress and
change in practically all social organizations, of which
hospitals are one, and also in all community work and
routine. In recent years, this has also almost revolu-
tionized relations between society as a whole and the in-
dividual. This idea is the recognition of the principle that
the individual loss or gain is common loss or gain, that
each individual is affected by and therefore interested in
others, and that there rests upon society a right, a re-
sponsibility, and a duty, to protect itself and help the in-
dividual in need. This idea has invaded the hospital field,
and under its influence hospitals, as institutions, have ma-
terially changed. The hospital patient is no longer merely
professional material, or simply a sick man requiring pro-
fessional treatment, but an individual to whom sickness
has come to derange his entire living, all his service, and
all his responsibilities, while others (at least his family)
are caught in the misfortune. The patient and often the
entire family are changed from an asset to society to a
liability. It is recognized that all the damage is damage
to the community and that there is not only a right,
but an obligation, to interfere to lessen the loss. In these
days we see posters warning us that every careless acci-
dent is a national calamity and all needless loss of work-
ing time, unpatriotic, indefensible, and inexcusable.
It is desirable and more efficient if all the work to be
done between the incident of sickness and the return to
normal life, together with the subsidiary problems, be
handled, in so far as is possible, or at least correlated, by
one institution, which shall be developed equal to this
work. Although the proper development of the hospital,
as such an institution, has not yet progressed very far,
there is a decided tendency in this direction which is ac-
celerating rapidly. The hospital is reaching out more and
more from the narrow field of professional work to cover
situations which certainly have more or less direct bear-
ing upon the medical problems, and which have even
greater bearing upon the problem of preventing individual
detei'ioration and hastening rehabilitation. In this, the
development of the hospital social service department has
been the largest factor.
There are, however, other indications of this transition
in the hospital as a social institution. There has been a
decided tendency away from medical staff control of the
entire institution, although a more complete control by
each medical service or department head within the re-
spective department. The principal of the training school
has also come to have duties more definitely circumscribed
by the I'equirements of her department. There is less of
a tendency to control detail on the part of the especially
interested supporter or active trustees, and a more gen-
eral recognition by all trustees that the position is an
important public trust and the proper discharge of its du-
ties requires specific technical knowledge and experience.
.A.11 the administration of the hospital dropped by these
other departments has been taken up by the superinten-
dent and made to count toward greater social efficiency
for the institution. This has caused a necessity for more
careful selection of superintendents, lai'ger salaries, better
and broader men, with the result that the number of
medical men going into administrative work has increased.
THE MODERN HOSPITAL
343
Greater opportunity for ccnstructive social work has
proved an attraction. The arguments for the superin-
tendent with medical training are obviously identical
with the arguments for the hospital social worker with
medical training:.
It is, therefore, no longer sufficient to consider that
simple relief to the patient's physical ills is hospital work
well done, completely done, or efficiently done. The hos-
pital has come to have a i-esponsibility, which consists of
playing its part, a large part, in helping to minimize all
the damage from the sick individual and to repair that
damage as quickly and easily as possible. In these days
of failing man-power, the days of work missed either
through illness or other causes has acquired an impor-
tance which we will not soon forget, and the existing
trend to minimize loss through illness has thereby been
greatly accelerated.
Here the best of medical service plays a part, but only
a part. When it has done its utmost, there remains much
which other means can accomplish, both as an aid to the
medical work and independent of it. The chief torments
of the average patient are not from the pain of his dis-
ease, but from the consciousness of inability to meet his or
her responsibilities and obligations in life. It has been ob-
served that hopeful, enthusiastic men, wounded in an ad-
vance, stand the shock of wounds better than tired, de-
spondent, depressed men, wounded in a retreat. The work
of the hospital as a modern social institution is then, pri-
marily, to render every aid to the individual medical sci-
ence can give and, secondly, to analyze the patient's indi-
vidual responsibilities and the situation created by his
temporary inability to meet them and, directly or through
the cooperation which has come to exist between social
agencies, to prevent deterioration and promote rehabili-
tation. The experience of the government in the rehabili-
tation of soldiers will become a guide for the future and
will advance this work as nothing else could have done.
This nonprofessional work in medical institutions has
come to be called Social Sei'vice, and its importance is
secondary only to the medical work in the big problem of
conserving human life and energj\ The importance, the
position, and the organization of the social service depart-
ment in any hospital defines exactly the attitude of that
hospital as a social institution toward the larger field.
The number of paid workers may as yet also indicate the
financial resources, but the oi'ganization of the depart-
ment in the routine process of the institution is something
apart from numbers. This nonmedical field is sui'ely
large enough to require an independent department, hav-
ing the same relation to the administration of the insti-
tution as other essential departments.
Social service and hospital efficiency are, therefore, re-
lated in a double way. The contribution of social service
to medical efficiency is no longer a question and conse-
quently has not been discussed in this paper; for it is
agreed that in this way, social service contributes indi-
rectly to hospital efficiency. The larger contribution,
however, is that direct contribution to the conservation of
human energy which social service makes, not by aiding
the medical work, but by direct service to the patient as
an individual, to reduce the economic loss through him
and his family and to hasten the return to full usefulness.
As the medical work is the pi-imary object of the hos-
pital, so its proper accomplishment must repi-esent more
than half of the measure of the institution's efficiency.
But as the ideal maximum results to be attained through
the modern hospital have broadened and grown, the con-
tribution which social service makes to hospital efficiency
has increased in that same proportion.
The important work of the social service department,
as outlined above, cannot, however, be well done by recent
graduates of nursing schools or of schools of philanthropy.
Not only is an understanding of the fundamentals of the
medical conditions required, but a far reaching knowledge
of sociology which will permit of rapid and accurate an-
alysis, and also a mature judgment as to the best means
to be used. This combination of talent is not now read-
ily obtained, and a proper general development of hos-
pital social service work must await the creation of means
for producing personnel equal to the supervision in this
important department. The question is now receiving
some intensive consideration, and the univei-sities have
shown a desire to acquire and give the technical educa-
tion demanded by this new field. The promotion and the
development of these schools and their courses of training
are worthy of every aid that the American Hospital As-
sociation can render.
HOSPITAL SOCIAL WORKERS HOLD FIRST
GENERAL MEETING
Convene at Atlantic City in Conjunction With American
Hospital Association to Discuss Problems of Mutual
Interest — Program Presented
The American Association of Hospital Social Workers,
held at Atlantic City, September 24 to 26, its first general
meeting since its organization at Kansas City last May.
The time and place were chosen to give the members an
opportunity to attend at the same time the annual con-
vention of the American Hospital Association.
War work in connection with hospital social work was
the topic of most genera! interest under discussion. The
programme on this subject included a report by Miss Jar-
rett of the Boston Psychopathic Hospital on the Smith
College Training Course in Psychiatric Social Work,
which is training workers to deal with war neuroses; re-
ports by Miss Mary H. Combs of New York and Miss Ida
M. Cannon of Boston, on social work under the depart-
ment of Military Relief of the Amei-ican Red Cross, in
the army and naval hospitals, and a report by Miss
Wadley of New York on the work of the Social Service
Department of Bellevue Hospital for the children's year.
Mr. Michael Davis of the Boston Dispensary presented the
question of the relation of hospital social work to the
Health Division of the Committee on Methods of Ameri-
canization, and aroused much interest in a plan of co-
operation with the Association of Hospital Social Work-
ers in the study of health problems of the foreign born.
The following resolution, which was adopted by the
American Hospital Association in general session, is of
great interest to all hospital social workers and seems
likely to promote the progress of social work in hospitals:
Resolved, That the American Hospital Association ex-
press a recognition of a general need of a large number of
women to supervise hospital social service work, w-ho shall
have the advantages of training by a university in prepa-
ration for such work; that the essential elements in such
an education are (1) general educational; (2) medical;
(3) sociologic; and that this work be so combined as to
make a university course of reasonable length; and be it
further
Resolved, That the executive secretary shall send copies
of this resolution to such universities as do now give prac-
tical courses in philanthropy and sociology and to any
other universities contemplating the establishment of
such courses.
Emphasizing as it does the importance of a standard
training, this resolution goes to the root of the business
344
THE MODERN HOSPITAL
before this generation of hospital social workers — namely,
the building of a profession, and of one which shall be a
real essential to the civilized community.
Report of Meeting of Representatives of Episcopal
Hospitals
As arranged at the Cleveland, 1917, convention, a con-
ference of repi-esentatives of the Episcopal hospitals was
held in Parlor "C," Royal Palace Hotel, Thursday, Sep-
tember 26, 1918, commencing at 3 p. m., with the follow-
ing present: Rev. F. R. Jones, chaplain Willard Parker
Hospital, New York City; Rev. F. M. Crouch, secretary
Social Service Commission, General Episcopal Church,
New York City; Miss T. M. Jennings, St. Luke's
Hospital, San Francisco, California; Miss A. M. Gaggs,
Norton Memorial Infirmary, Louisville, Kentucky; Rev.
John W. Walker, representing Trinity Hospital, Winner,
.■South Dakota; Miss Florence M. Thompson, superin-
tendent St. Luke's Hospital, Davenport, Iowa; Mr. Cor-
nelius S. Loder, representing managing director Christ
Hospital, Jersey City, New Jersey; Rev. Dr. Jeffrey, su-
perintendent City Mission Society, Philadelphia, Pa. ; Miss
Hartry, St. Barnabas' Hospital, Minneapolis, Minn. Rev.
Mr. Jones acted as chairman of the meeting, and Rev.
Mr. Walker acted as secretary.
The object of this conference was to effect a closer co-
hesion among the Episcopal hospitals for the solving of
their own problems, and for a greater interest in the
American Hospital Association. It effected an organiza-
tion in the appointment of a committee which will meet
in New York shortly to draw up and map out a plan for
the attainment of the objects of the conference. The men
who have been asked to serve on this preliminary organ-
izing committee are: Rev. F. R. Jones; Rev. Mr. Clover,
superintendent St. Luke's Hospital, New York City; Rev.
F. M. Crouch; Rev. Paul F. Swett, superintendent St.
John's Hospital, Brooklyn, N. Y.; Mr. Cornelius S. Loder;
Dr. Henry Barton Jacobs, Baltimore, Maryland; Sister
Superior, superintendent St. Barnabas' Hospital, New-
ark, N. J.
It was the unanimous opinion of all present that there
is a province for such a conference or committee as
planned above, and it is urgently hoped that all Episco-
pal hospitals will endeavor to cooperate with the com-
mittee by sending answers to any communications they
may receive from it, and also by presenting to the com-
mittee any problems they may have, which the committee
may be able to solve for them, or in the solution of which
they may be able to assist.
VACATION SHORE COTTAGE FOR NURSES
The Connecticut Training School of the New Haven Hos-
pital Believes That Nurses Should Be Kept
Physically Fit
Haver Hospital,
By SIMON F. COX. M.D.. Superintendent N
New Haven, Conn.
Until recent years the life of a nurse in training, in
contrast with the custom of today, was one of extreme
drudgery. Today no hospital or training school manager
fails to realize his or her position as an educator, and
training schools are taking their place where they right-
fully belong, namely, as a vital part of the hospital and
essentially an educational unit.
With the awakening of hospital and training school
boards of managers to their responsibilities comes the con-
sideration of the needs for healthy bodies in the groups of
nurses. More attention is being paid in the planning of
dormitories to the nurses' physical development, and we
have the gymnasium, the tennis and squash courts, and
various other devices under supervision of physical direc-
tors.
The training of a nurse is intensive work and study for
a period of three years with but little break for recreation,
and many a nurse receives her diploma on the verge of
threatened broken health and is compelled to seek an
extended rest before she can begin the practice of her
profession.
Training schools should see to it that their recent gradu-
ates are physically fit and ready on graduation to take
up their work. As an experiment to this end the Con-
necticut Training School for Nurses of the New Haveii
Hospital of New Haven, Connecticut, provided a seashore
cottage for the use of the nurses. This cottage is open
from May 15 to November 1. Search was made for a
suitable seaside cottage which should be close to the city
and sufficiently large to permit at least one dozen nurses,
a housekeeper, and a maid to sleep there. It should have
an adequate kitchen and dining room to feed twenty-five
nurses. There should be a plot of land sufficiently large
to give seclusion, and, in addition, a private bathing beach.
We felt these provisions would serve the training school of
The seashore cottagre provided by the Connecticut Training School of
the New Haven Hospital for the vacations of its nurses.
a hundred pupil nurses. Happily a secluded cottage on a
three-acre plot with a private bathing beach was found in
Woodmont, close to a trolley line. This house was rented
and furnished with standard nurses' dormitory furniture
and formally opened with a resident housekeeper and a
maid.
It was planned to furnish for such nurses as remained
over night a substantial breakfast. Other meals were of
the cold variety and consisted of cold meats, salads, etc.
Supplies were sent daily from the hospital, the meats
and such things being cooked in the hospital kitchen.
The night nurses slept in the cottage during the whole
summer and could easily have their dip in the ocean, eat
supper and return in plenty of season for their night
work. Week end and even vacation periods are spent
there with profit by the nurses.
We were interested to note the general health of the
nurses during the following winter as compared with other
years and we were not surprised to find that the number
of days lost by sickness had been decreased over 40 per-
cent.
THE MODERN HOSPITAL
345
Work in Chinese Women's Hospitals
To the Editor of The Modern Hospjtal :
Your letter of March 11 arrived some time ago, while
I was very busy nursing one of the men of the mission.
I returned to the city on Tuesday of this week from the
university campus outside the South Gate.
As you probably are aware, we newcomers have to have
two years language study, helping in some work the sec-
ond year, to get a better working vocabulary than one
would get from books. Some of the translations of our
Fig. 1. Methodist Men's Hospital, Chengtu, China
American nursing text books are in Gwan Hwa, or official
language, more of them in "Wen li," or very high liter-
ary style, while the people use "Tu Hwa" (earth words);
so you see what a problem we have here, just in the lan-
guage. The year I came out, two of our West China phy-
sicians had to return to America; so we have three closed
hospitals, two in Chungking and one in Chengtu. It is no
doubt fortunate for me that the hospitals were closed,
for, ;f they were open, 1 probably would have had very
little time, if any, for language study.
We feel that the Chengtu hospital should be opened first
to afford a place for clinical work for the students in the
medical school of the West China Union University.
There is a men's hospital operated by the Canadian Meth-
odist Mission, but, so far, there has been no place for ob-
servation of women's and children's diseases. And the
babies and children need care, oh, so much! In West
China it is estimated that from 85 to 88 percent of all
babies die before they reach their second birthday. Do
you wonder that Dr. North of our Mission Board in New
York before I came out asked me to work especially along
infant welfare and prenatal care lines ? And the children
are loving and lovable. Babies and children are the same
the world over.
During February our hospital was crowded with wealthy
families who had come in to protect their growing daugh-
ters from the ill designs of the southern soldiers. One
afternoon in the hospital chapel I told the women and
their serving women about the care of new-born babes —
especially, of the care of the cord to avoid tetanus (thou-
sands of babies die in Chengtu each year from tetanus,
due to the use of dirty, rusty scissors). While I was talk-
ing the husbands gathered about the outer door to hear
about their babies. After that the men and their wives
brought their babies each day and, where they needed
a doctor's advice, I had Dr. Canright see the babies and
order what was necessary. Very often the advice needed
is more about cleanliness and feeding.
Under separate cover I am sending a report of the
Chungking Women's Hospital, which is closed, as Dr. Ed-
Fig. 3. Dressing Sores, Chengtu Beggar Reformator>-. West China
monds, deai-ly loved and respected, is in a tuberculosis
sanatarium in Los Angeles. There has been no one to
take her place; so this wonderful opportunity is being
lost. Our hospital here has been closed since before J
arrived.
In regard to our helpers, for two years there will be no
graduate^ in medicine. Aside from the physician and
nurse in charge, all other helpei-s must be taught and
trained. Owing to Chinese ideas of propriety, a woman
nurse can not go into a man's room; so it is necessary for
346
THE MODERN HOSPITAL
men's and women's hospitals to be separate, with male
nurses for men and women nurses for women.
The patients coming now to the dispensary are rich and
poor, high and low. One day recently there were four-
teen officials' wives.
I feel that this is a very rambling letter, but, as soon
as I can get into work, I shall be glad to write about
adaptations of home methods to Chinese conditions. How-
ever, during this past year, Szechwan has been torn with
dissension, and Chengtu has had two long sieges of shell
fire and burning. Chengtu was a city, according to Chi-
nese history, when Abraham started to seek the Land of
Promise. Marco Polo visited Chengtu in his day. It was
capital of one of the three kingdoms during early history.
It is now capital of this vast province, the richest in
China. Beatrice W. Murdoch,
Chengtu Hospital, West China Mission, Methodist Episcopal Church.
Chengtu. West China
Associated Purchase Method Adopted by Australian
Institutions
To the Editor of The Modern Hospital :
It will interest you to know that the method adopted by
the principal public institutions here in connection with
the purchase of their main requirements is to work on the
basis of associated purchases. Our institutions are sup-
ported by public subscriptions and also by grants of
money from the government of the state. Each institu-
tion in the past looked after its own purchases, and it
was found through various causes that for common re-
quirements such as bread, meat, and drugs certain insti-
tutions were paying very much more than others.
It was felt by the governing bodies, that, as far
as the public charitable medical institutions were con-
cerned, the policy of combining quantities for contract and
direct purchase would enable stores of various kinds to
be purchased in larger quantities (including drugs, drap-
ery, meat, bread, etc.), and thus enable the lowest supply-
ing price to be secured. The Hospitals' Board of Supplies
was therefore established, employing a secretary, and
having on the board one representative from each of the
main institutions concerned. The plan has worked out
favorably where definite standards can be arrived at.
It is obviously simple enough to establish a standard
for bread, and by combining orders for one or other of
the larger institutions we can certainly do better in our
purchases than if we purchased for each institution indi-
vidually. We standardize requirements in bedding and
drapery, and with us drugs are naturally standardized
on the British pharmacopeia basis. We are certainly able
to buy most of our commodities at better prices than trad-
ers because we go as near as possible to the fountain
head, or original supplier. Besides this, we claim that in
our purchases we are not competitors with traders, for
the reason that we do not distribute our goods amongst
the public, and, .consequently, our claim to purchase on the
best possible basis has become recognized.
In a general way the foregoing explains our system.
We have in addition instituted a series of meetings
which prominent officials, such as secretaries, matrons,
medical superintendents, etc., can attend and discuss im-
portant subjects such as hospital provedoring, efficiency
and economy, utilization of wastes, and also subjects such
as the testing of articles with a view to ascertaining the
best standards which will give the greatest economy in
working.
We have in anticipation lectures on modern hospital
building, lighting, airing, and such other subjects as are
akin to the interests involved.
The main point, however, with regard to our particular
department of work is the business end of the hospital as
distinct from the scientific and professional side. Most
of the members of our board are business men, and their
e.xperience is certainly of great value to the institutions
concerned.
I am engaged in business in this city and I think I am
correct in stating that this in itself was one of the spe-
cial qualifications required in the secretary in view of
the purpose for which the board has been established.
For the HOSPITALS' Board of Suppeies,
W. H. MacLennan, Secretary,
Melbourne, Australia.
Work of the American Woman's Hospital in France
To the Editor of The Modern Hospital:
Things are happening rapidly in the American Women's
Hospitals. We have established a military hospital, the
first to be established by American medical women in
France.
As noted in the article I wrote for you, which was
published in your July number, we started to establish a
small civilian hospital in the department of the Aisne,
with Dr. Barbara Hunt, of Bangor, Maine, as director.
As soon as we had taken possession of the chateau in
Neufmoutiers, placed at our disposal by the devoted and
charitable French owners, we were asked to double the
beds in this hospital, and before we were able to do even
this, the commandant of the Sixth Army Corps asked us
to establish a military hospital of one hundi'ed beds just
behind the lines, which should be expansible. This we
have done.
I believe this to be the beginning of a series of military
hospitals which we will establish. Just now our Dr.
Purnell, accompanied by a staff, is sailing for Europe with
an idea of inspecting this hospital and making a genera!
survey of the medical situation in France.
Charlotte M. Conger,
Executive Secretary, .American Women's Hospitals, New York.
BOOKS RECEIVED FOR REVIEW
The Treatment of War Wounds. By W. W. Keen, M.D.,
LL.D., Major, Medical Reserve Corps, U. S. Army,
Emeritus Professor of Surgery, Jefferson Medical Col-
lege, Philadelphia. Second edition, reset. Cloth, pp.
276, illustrated, $2. W. B. Saunders Company, Phila-
delphia, 1918.
How Shall I Take Exercise and Set-Up? A Physician's
Analysis of the Why and Wherefore, What's What, and
What's Worth While in Exercise, with illustrated move-
ments. By Samuel Delano, M.D. Cloth, pp. 13.5, illus-
trated. $2. The Four Seas Company, Boston, 1918.
The Hospital as a Social Agent in the Community. By
Lucy Cornelia Catlin, R.N., Director of Social Service
Work and Executive Director of the Out-Patient De-
partment Youngstown Hospital. Ohio. Cloth, pp. 113,
illustrated. $1.2.5. W. B. Saunders Company, Phila-
delphia, 1918.
Reclaiming the Maimed, a Handbook of Physical Therapy.
By R. Tait McKenzie, M.D., Major R.A.M.C, Professor
of Physical Therapy University of Pennsylvania. Flex-
ible leather, pp. 238, illustrated. $2. The Macmillan
Company, New York, 1918.
Report of the Department of Health and Sanitation of the
City of Seattle, Wash., embracing the work of the de-
partment and the vital statistics for the calendar year
1916.
Everyday Foods in War-Time. By Mary Swartz Rose,
Assistant-Professor, Department of Nutrition, Teachers
College, Columbia University. Cloth, pp. 117. 80 cents.
The Macmillan Company, New York, 1918.
All persons interested in the collection of fruit pits are
urged to help facilitate the packing and shipment thereof
by drying them thoroughly.
THE MODERN HOSPITAL
347
NEW
INSTRUMENTS
AND EQUIPMENT
VINCENZ MUELLER. Tec
GEO. W- WALLERICH, As.
:al Editor
ate Editor
Please address items of n
ments and Appliances to the
avenue. Oak Park, Illinois.
Knitted Gauze Dressings
How to consei-ve and re-use surgical dressings over and
over again, is one of the most important questions whicli
confronts our hospitals today.
A step in the right direction toward solving this prob-
lem is the method of preparing surgical dressings devel-
oped by the Re-Use Knitted Gauze Company, of Kankakee,
111., in conjunction with the Surgeon-General's Depart-
ment. Thorough trials in several base hospitals in this
country have convinced the authorities that the use of
these knitted dressings of various shapes and sizes is so
satisfactory and economical that it will result in the i-e-
lease of large quantities of gauze for our forces abroad.
Re-Use Knitted Gauze Dressings are made from high-
grade cotton, knitted in tubular fomii and finished in vari-
ous shapes. They are highly absorbent, soft in texture
and when properly reclaimed can be used indefinitely.
They are to be applied in hospital and surgical work
exactly as woven gauze, and the manufacturers claim that
the cost of surgical dressings in a hospital can be reduced
by several hundred percent, depending upon the care with
which the process of reclaiming is carried out.
Fig. 1. Piece of knitted gauze folded making an ideal sponge.
The knitted gauze can be folded for use as compresses
sr pads, and is made in a number of sizes, such as 4 by
4 inches, 6 by 8 inches, etc. Absorbent pads 8 by 12
inches and 12 by 24 inches, as well as abdominal rolls,
are also furnished, and the material is knitted into various
shapes for use as head covers to keep scalp dressings in
place, for surgeons' operating helmets and ward masks,
and for use in isolation wai-ds, as well as in tubular form
for use under plaster casts.
We thoroughly
believe that it will
be well worth the
time of every hos-
pital manager to
investigate this
proposition, both
from the point of
view of cost, as
well as on account
of the great sav-
ing of labor that
will result from
using indefinitely
these prepared
pieces of sponges,
pads, etc.
'inished piece of knitted gauze befo
being folded into sponge.
Parallax Foreign
Body Localizing
Instrument
This instrument,
which was devised
by Capt, E. S.
Blaine, M.R.C.,
makes use of two
well-known princi-
ples of foreign
object localization
with the x-ray, the Fi
"parallax" and the
"double ring," The feature of the instrument is in the
three dii-ect reading scales graduated in quarter centi-
meters, which give the depth of the projectile below the
upper skin surface, the height from the under skin sur-
face and the distance laterally from the skin at the level
of the object. The under and side points are conveniently
marked on the skin by pressure plungers which actuate
inked wicks.
The principle of the parallax is that the shadows of
objects at different distances from a source of light will
move at difl^erent speeds and distances in accordance with
the moving of the light parallax to the plane of the sur-
face upon which the shadows are projected. Thus the
closer the object to the light the greater will its travel
be. Therefore, if two objects ai'e at the same distance
or level, their speed and distance of travel will be iden-
tical. By this means one obtains the exact level at which
two objects lie. If one can measure one of these it fol-
lows that the other is at the same level or depth.
The double-ring principle is that of two rings directly
superimposed and in line with a third object between
them; their centers will represent the true vertical line
upon which all three lie. Substituting the x-ray for the
source of light, the same conditions will be obtained, and,
if the inlet and the outlet of the vertical ray be marked
on the skin, we have the line upon which the foreign ob-
ject lies, regardless of rotation of the part.
The operation is entirely fluoroscopic, thus doing away
with the need of plate exposure and consequent develop-
ing and delay due to the handling of the plate or film.
The instrument consists of an aluminum base, contain-
ing arm and brass ring with skin-marker in its center
concealed ' •. the body of the base, an upright post which
carries two horizontal arms, the upper one having a ring
set exactly above the one in the base, the lower of the
two being the parallax arm. This arm is a square tube
graduated on its upper face in quarter centimeters, indi-
348
THE MODERN HOSPITAL
eating the distance from the center of the rings. The
tube also contains a push rod with a skin marking wick
at the end, which is saturated with special ink. This
c t^:^,
Parallax foreign body localizing instrument.
arm is adjustable vertically on the upright post, and hori-
zontally on a sleeve on the same collar, on the post. The
upper rod is adjustable vertically only, both the upper
and lower rings being fixed in position. The patient is
examined for the approximate position of the foreign ob-
ject, after which the base of the instrument is carefully
inserted under the part, and the rings placed as near to
the vertical plane of the projectile as possible, and the
upper ring is just above the upper skin surface with the
parallax rod drawn back, so as to allow the free move-
ment of the instrument.
Under the x-ray the instrument is moved, the two rings
being exactly superimposed on the shadow of the projec-
tile. A sheet of clear celluloid, ruled in parallel lines, is
placed on the skin surface with one of the rulings in line
the ring. The operation is now completed, except for
reading the figures.
The scale is read in the following manner: "A," the
depth from skin above to the projectile on the left hand
vertical scale; "B," the height from skin below on the
right hand vertical scale; and, "C," the lateral distance
from the side skin mark on the scale on the parallax rod.
The three resulting ink marks on the skin permit the
surgeon to choose any one of the three routes of approach
to the foreign object; he will be guided by the anatomy
of the region as well as the surgical indications.
This instrument is one of the several standard methods
adopted by the U. S. Army Medical Department for use in
projectile localization, and all student officers in the course
of instruction in roentgenology are being trained in its
use and application. It is stated that the degree of accu-
racy with which this instrument locates projectiles, leaves
but little to be desired and that it is seldom that the
foreign object is found more than 1 or 2 mm. off from
its true location in the tissues.
with the shadow of the arm of the instrument. Tne x-ray
tube is then displaced to right or left until the shadow
lies on the same line, the parallax rod is raised or lowered
until the middle of the shadow lies on the same line as the
shadow of the projectile. The upper ring is lowered
until it touches the upper skin surface, which is marked
with indelible ink and the parallax rod is moved forward
until it touches the skin, when the plunger is depressed
and the skin is thus marked on the side on a level with
the shadow of the projectile. Then the plunger, which is
concealed in the base and to which i.s attached an articu-
lated arm or hammer with inked wick, is pushed forward,
which causes the skin to be marked in the lower center of
Anesthetic Screen
This device, as designed by Dr. E. B. Dench, New
York, is intended for use during mastoid operations, in
order that the operator and anesthetist may have
separate and distinct fields for their work.
After the patient has been put under the anesthetic, the
lower plane of the apparatus is slipped under the rubber
Dench anesthetic screen.
pad or cushion supporting the head. The two posts
which support the upper plane are inserted into the bind-
ing terminals and the entire apparatus adjusted so that
the free margin of the upper plane lays on the patient's
temple just in fi-ont of the ear. A sterile sheet is then
draped over the top and on the sides, so that the operator
is afforded protection from the fumes of the anesthetic,
and the anesthetist has a clear view of the patient's face,
which, together with the anesthetizing apparatus, is
isolated from the field of operation.
The upper plane of the apparatus also forms a handy
resting place for instruments when not in use. The device
can be folded into a compact form so that it may be
easily transported in the surgeon's instrument bag.
Dr. W. W. Keen, of Philadelphia, states that anti-
typhoid vaccination has practically banished typhoid from
the camps at home and the armies in Europe.
..L\'\
THE MODERN HOSPITAL
A Monthly Journal Devoted to the Building, Equipment, and
Administration of Hospitals, Sanatorinms, and Allied Institutions,
and to Their Medical, Surgical and Nursing Services
November^ 1918
AT THE SIGN OF THE BLUE CROSS
What Is Bein^ Done for the Horses on the French and Italian Fronts— Methods of Treat-
ment in the Blue Cross Hospital
By CHARLES W. FORWARD, Editor, Animals' Guardian, and GEORGE FREDERIC LEES, London
THE entry of the United States into the great
struggle on the battlefields of Europe for the
freedom of the world has quickened public inter-
est on both sides of the Atlantic in the welfare
of the horse. What is being done to reduce the
sufferings of our equine friends who have been
called upon to share our burdens? — is a question
that everyone who is a lover of animals (and who
is not?) is asking. It is, indeed, an important
question, one in which Americans are specially
interested, considering the very large number of
horses that will be required by the United States
before the war is over and the many thousands of
valuable animals that must of necessity come
from the New World. It has been calculated by
a well-known American journal that the United
States Army will require one horse to every four
men. An army of four to five million men has
been spoken of as necessary. If that be so, what
a vast army of horses we shall have on the various
battle fronts before the day of victory dawns !
Horses, like men, quickly fall sick and grow
"war-weary." Scourging diseases are lurking all
along the path of the gallant horses and mules
which, in tens of thousands, have assisted the
soldiers of the entente powers to gain victorj'.
Only those who, like ourselves, have been at the
front, can realize the horror of such dreaded
scourges as sarcoptic mange, due to constant work
in mud and attendant exposure to the icy winds
of winter.
Many people believe that the horse is a robust
animal and will stand any amount of rough usage
and bad conditions of life. Never was there a
350
THE MODERN HOSPITAL
greater mistake. The horse is indeed most sus-
ceptible to illness. He easily catches cold and
gets a fever. Respiratory troubles easily get a
grip of him. Fortunately, this fact is well known
among the officers of the veterinary service of the
armies, and all sorts of precautions are taken, as
soon as horses are landed from England, to pro-
tect mounts from coughs, fevers, catarrhs, pneu-
monia and pleurisy — and with marked success.
We are glad to say that these ailments are com-
paratively slight among horses at the front.
Notwithstanding, already the suffering among
war horses has been terrible. It was calculated
some little time ago that, leaving Mesopotamia
and Africa (except Egypt) out of consideration,
more than 250,000 horses had died, while, in
addition, over 30,000 had been sold owing to age
and disease. No fewer than 33,000 animals were
reported to have died in America whilst awaiting
shipment, whilst 6,000 died at sea. That is to
say, nearly 40,000 horses purchased for military
purposes never became available. Apart from
the humanitarian standpoint, there is here a loss
that cannot be tolerated. We must husband our
forces in horse power as in man power, and see
that everything is done to relieve the sufferings
of those dumb creatures whose aid we are em-
ploying for the benefit of humanity.
Just now, during the great fight which is taking
place in France and Flanders, horses are having
a great deal more work to do than they had dur-
ing trench warfare. What is happening to them?
One of the writers, who has just returned from
the front can answer this question in the form of
a little chose vue.
The incident he observed occurred not far from
Mareuil. A body of dragoons were on their way
to hold up a German thrust and they came under
heavy shell-fire. Many of the horses were
wounded and their riders, thrown to the ground,
were under the painful necessity of abandoning
their steeds. The duty of these soldiers was clear.
They could not leave their animals to die a linger-
ing death, so, drawing their revolvers, they pro-
ceeded to put them out of their misery. It was
one of the most touching sights imaginable. Many
of these men had tears in their eyes ; some even
turned their heads away as they pulled the trig-
gers. That was to avoid the look of wondering
reproach which the poor beasts turned on their
masters. But there was nothing for it but to
end their misery in that way ; they were too badly
torn in flank or belly by fragments of shells to
make it possible to remove them to the hospitals
of the Blue Cross.
These Blue Cross hospitals in France are doing
a most magnificent work. They are the outcome
of a fund started in 1912 by "Our Dumb Friends'
League," a London society for the encouragement
of kindness to animals, the president of which is
the Right Hon. the Earl of Lonsdale. The presi-
dent of the Blue Cross Fund (58, Victoria Street,
London, S. W. I.) is Lady Smith-Dorrien. The
hospitals are situated at Moret (fifteen wards),
St. Mammes (five wards ),Provins (seven wards),
La Grand Romaine, and Faviere. The material
organization of these depots is always the sub-
ject of the greatest attention, the rules presiding
over their installation being first of a hygienic and
secondly of an economic order. The premises,
altered according to needs, include comfortable
Fig. 3. Diagnosing
nd in the shoulde
stables with plenty of light and air. The ground
is laid in such a way that hygienic cleaning is
rendered easy and efficacious; it is slightly slop-
ing backwards, so that the liquids may quickly
run off ; and the ground is always covered with a
plentiful litter, renewed twice daily. Oats and
other food are distributed in stone or stick board
mangers, located low enough to allow the horse
to feed in the normal horizontal position of its
entire spine. The greatest attention is paid to
grooming. Drinking water is from streams run-
ning close by the stables; its good quality has
THE MODERN HOSPITAL
351
been proved by chemical analysis. In the neigh-
borhood of the depots are large natural meadows,
in which hospitalized horses can graze freely, with
the benefit both of green pasture and of beneficent
exercise in open air.
With the exception of St. Mammes, the organi-
zation of each depot is identical. It includes a
surgery and a pharmacy room, inside the largest
hospital, where are grouped all the injured horses
requiring serious operations and constant care.
A second hospital is exclusively devoted to sick
horses, and these are in veiy limited number.
Contaminated animals are thoroughly isolated in
special places. This category is chiefly composed
of inangy horses, other catching diseases being
practically unknown, thanks to the prophylactic
measures taken by the veterinary military serv-
ices and by the technical service of the Blue Cross.
Lastly, to each depot is annexed a simple farrier's
shop.
The specialty of each of the above named hos-
pitals will be seen from the following table :
MORET
Birmingham Ward — Horses in good form.
Margaret — Suspected, isolation.
Huddersfield — Surgery and pharmacy.
PROVINS
Alexis Ward — Surgery and pharmacy.
Victoria, British Columbia, Ward— Gravely wounded
and over-ridden.
Fig. 4. Irrigating
the horse's neck
Ogden Ward — Parasitic diseases.
Tornau, Great Amwell Branch — Wounded, over-
strained.
Ste. Colombes, Hartley Wintney — Lameness, fatigue.
Fleet — Knocked up.
Philadelphia — Surgery and pharmacy.
Post Card Guild — Parasitic diseases.
STE. MAMMES
Edith Cavell Hospital — Epizootic lymphangitis.
Parasitic diseases, such as skin itching, have
exacted a considerable effort from the veterinary
surgeons and workers of the Blue Cross in France,
and greatly delayed the return to fitness of the
sick horses. But the veterinaries have remained
masters of the situation, and for the present this
disease has disappeared from the depots. As to
internal illnesses, we can state they hardly exist,
thanks to good hygienics.
As the manager of the veterinary service to
which the Blue Cross belongs has reported to the
society in London, "these depots are remarkably
Fig. 5. Probing a bullet wound on withers.
well kept and the results are excellent. Nothing
but congratulations can be addressed to the man-
ager and to the veterinaiy practitioners. At the
present time five thousand horses have been pro-
vided for by the Blue Cross in France, and sent
back to their duties."
We were told by the veterinary surgeons of the
Blue Cross that the two most serious troubles
they had to contend with were mange and other
allied skin diseases and ophthalmia. The former
is essentially a winter disease, and as one of us
was in France during the snowy weather he saw
a number of very bad cases, which were all cured
by the well-known dipping method. There are
three forms of mange, sarcoptic being by far the
worst. The pai-asite burrows under the skin,
where it lays its eggs and thus produces a most
horrible and painful eruption. As a precaution
against germs harboring in the horses' coats,
these are cut before the advent of the cold
weather — namely, in October and November.
Nevertheless, our four-footed allies succumb to
the dread disease, patches of which you will gen-
erally see in the region of the mane, neck and
withers. Formerly, the treatment used to be
dressings of sulphur ointment; but now, as pre-
viously mentioned, dipping is the method em-
ployed. In brief, the mangy horse is given a bath
in a heated fluid of calcium sulphid. This bath
is in the shape of a long and deep well and is part
of the ^■^sential equipment of every up-to-date
hospital in France. The patient passes in at one
end, down an inclined plane and must perforce
plunge into the dip, after which he struggles out
352
THE MODERN HOSPITAL
at the other end. This treatment is repeated a
number of times. Two months may be necessary
for his cure. Good feeding and careful groom-
ing, of course, do much toward turning him into
a healthy animal again.
French veterinary officers adopt another
method. They have an installation for treating
mangj^ horses by means of sulphurous acid gas
(SOo) during two hours at a time. They are put
into chambers, with only their heads protruding
into the open air. But we cannot say as to
whether this treatment has been found really
practical.
General debility is another of the ills to which
horseflesh is heir. Under the conditions of
Fig. 6. Extracting
horse's hoof — a most delicate
modern warfare, it is not always possible for our
men to prevent the horses sinking to too low a
condition. How many advanced cases have we
seen in the depots of the Blue Cross! It must
also be remembered that the war has lasted four
years and that these have been added to the age
of our four-footed soldiers. It has been esti-
mated that about 10 per cent of the animals pass-
ing into our hospitals are fifteen years old and
over. We have always made a point of pressing
this fact in official circles, where it is often for-
gotten that it is poor finance and by no means
good policy to keep these horses any longer in the
army. What happens to those animals that are
discharged? Many of them go back to the land
and help the old men, the women and the chil-
dren of "la belle France" to cultivate the ground.
It gives one pleasure to think that they will be
well looked after and will live under the healthiest
conditions for the rest of their lives.
But let us continue to speak of other diseases
which the veterinary surgeons of the Blue Cross
hospitals have to combat. We have already men-
tioned ophthalmia. Iridocyclitis is the form most
prevalent in France. Its cause is unknown, but
it is doubtless due to errors in feeding, exposui'e,
irregular exercise, and a low vital condition. A
point to be mentioned is that horses from the
United States that have been fed on cottonseed
are very subject to the disease. Treatment in our
hospitals is the same as in those of the ophthalmia
veterinary hospitals of France: a hypodermic
injection just above the eye.
Microbean diseases are very common among
horses. Take the case of ulceritic cellulitis as an
example. If it attacks the kidneys, "No remedy!"
says the veterinary, and the poor animal must be
destroyed. But if it only just enters the skin and
causes a running ulcer, then the disease, thanks
to the progress made by leading bacteriologists,
can be fought and conquered. Out of 1,867 cases
which were treated between January and October
of last year there were nearly six hundred cures.
But the percentage has since been much greater.
We need say little as regards the treatment
of horses for wounds. It is practically identical
with that given to the soldiers suffering from
shell-splinters, shrapnel bullets, and bomb
splinters.
A well-known authoi'ity whom one of us met
in Pai'is gave us some very interesting official
figures concerning the horses and mules that have
been in the firing line. He said that no fewer
than 551,960 horses and mules had been admitted
to the hospitals and convalescent depots in France
from the beginning of the war until FebruaiT,
1916, and of these 394,768, or 71.5 per cent, had
been cured, leaving 34,327 still under treatment.
During the same period 16,215 died : while 106,-
650 had to be destroyed or sold. Eloquent figures
indeed, for they prove how very efficient our hos-
pitals, both official and private, are and how great
have been the strides made by veterinary science
since the wars of the past.
Splendid support has been given to the Blue
Cross by the Dominions, and substantial help has
come, too, from the United States, where Mrs.
Ellphinston Maitland has acted as representative
for the Blue Cross with marked success.
One of us, on the occasion of a tour of inspec-
tion of these well-equipped hospitals, was also
most favorably impressed with the appearance
of the horses under treatment. He found they
wei'e suffering from a variety of injuries, one of
the most common being saddle-sores. It seems
that the saddles, once put on, are seldom removed
under war conditions and, as they do not always
fit, unequal pressure causes large surface wounds.
On the saddle's being taken off, a portion of the
wretched animal's skin often comes away with it.
This is a difficult injury to deal with. Thorough
cleaning of the wounds and the application of
petrolatum dressing brings about a healing of the
surface, but the new tissue is extremely delicate.
THE MODERN HOSPITAL
353
Such horses ought never to be used again as
mounts, but only for transport work. There were
other cases of horses with shell and shrapnel
wounds. A large proportion, however, were more
or less broken-down animals, requiring merely
careful feeding, grooming and rest. What sorry
beasts these last-named were! A group arrived
at the depot at the same time as one of the writers.
The change when he next visited the hospital,
not more than three weeks later, was marvelous
to behold ; he could hardly recognize them as the
same animals. They had arrived in such a state
that they could harldy drag one leg after the
other; now they were frolicking around the pad-
dock, enjoying the crisp air (it was winter time)
and the warmth of the noonday sun.
The Blue Cross has also done splendid work in
Italy, which one of us visited when that country
was about to declare war. The visit in question
was in reference to the organization of a hospital
service for the Italian Army. The Blue Cross
Fund Committee voted a sum of 25,000 lire
(5,000 dollars) to the Italian Croce Azzura, and
a further sum of over one thousand dollars was
subsequently sent to help the Italian horses. A
third donation of 25,000 lire was sent by the
London committee, telegraphically, on hearing of
Cadorna's set-back.
In regard to the treatment of wounded horses
the Italians have been dreadfully handicapped.
As our readers will remember, the outfit pur-
chased for Lord Astor's hospital was captured by
the Germans at the time of their invasion of
Italy and the Italian army was placed at a grave
disadvantage. Hence the necessity of doing all
we can to help forward the cause not only in
France but in Italy, where the work of the British
Blue Cross is highly appreciated. On the journey
from Rome to London one of us heard this good
news repeatedly from the lips of French and
Bj-itish officers.
The Blue Cross Fund has received over 100,000
pounds (500,000 dollars) from all parts of the
world where Englishmen and lovers of horses
are to be found. And we should like this further
fact to be known all over the United States,
namely, that the Blue Cross is the only organiza-
tion with hospitals under its own control and
independent of the army, though working with it.
This money has been expended not only in the
upkeep of the various hospitals, treatment, etc.,
but in the purchase of veterinary requisites and
horse comforts. Who has not heard of the "Blue
Cross Veterinary Chests" — those handy, portable
chests containing a carefully selected supply of
instruments, bandages and rugs most frequently
needed in giving relief to wounded and sick horses,
far removed from the base or field dressing sta-
tion? Moreover, money has had to be spent for
thousands upon thou.sands of bandages, wither
and sheepskin pads, ointments and drugs, port-
able forges and clipping machines, chaff cutters
and poultice boots, pocket veterinary cases, spe-
cial waterproof rugs for winter use, canvas water
troughs, and fomenting pales.
How many thousands of letters have been re-
ceived at the London headquarters from the
grateful army officers! "Many thanks for the
grand lot of stuff you so kindly sent me from the
Blue Cross," wrote one cavalry officer. "I can
assure you it was most useful and most accept-
able." "I have today received," writes another,
Fig. 7. Searching for ;
neck of wounded horse.
"a hamper containing liniment, iodium, boracic
ointment, and powder ; also a day or two ago, a
pair of leather poultice boots. I very much appre-
ciate the good work your Fund is doing."
May we be allowed to say a few words in con-
clusion regarding another branch of the work of
"Our Dumb Friends' League," — the special atten-
tion which is being devoted in France to wounded
and sick dogs of war? A hospital has been
founded for these devoted four-footed allies. The
wonderful service that dogs of certain breeds
have rendered the French soldiers has at last been
recognized by the British authorities, who have
started the training of sentry and messenger dogs,
etc., on serious lines. Appeals are being made
to dog owners to contribute suitable animals for
war work. This appeal for dog-power must, of
course, be followed by the establishment of dogs'
hospitals. Here is a branch of work which will
have to be developed by the Blue Cross of Great
Britain !
I count that Investment most profitable which pays me
in dividends of Friendship. Money and position and
power art all valuable and may be of great service, but
none of these jnelds so great a rate percent of Happi-
ness as my investment in human kindliness and human
service out of which grow human friendship. — E. 0. G.
354 THE MODERN HOSPITAL
THE EDUCATIONAL WORK FOR CHILDREN AT LAKESIDE HOSPITAL
Need for Educational Advantages for Children in Hospital Americanization of Foreign
Patients — Organization of Educational Work in Lakeside
By a. R. WARNER, M.D., Superintendent, Lakeside Hospital, Cleveland, Ohio
WITH the development of the social service
idea there has come to many hospitals a
feeling of responsibility to patients which de-
mands that the entire welfare of the individual
be considered, served, and promoted. It is no
longer sufficient to receive patients without con-
sideration of why they are ill, to use them simply
as clinical material, or to make statistics, and
then to discharge them without a thought of their
present facilities for convalescent care or regard
for their future welfare. As a part of the broad
principle of responsibility to society and to the
individual patients, educational opportunities for
children received due thought and consideration,
for in a child mental development is second only
to health.
The beginning of the educational work in Lake-
side was the foundation of the Page Kinder-
garten Fund. This was a fund given by Mr. and
Mrs. E. S. Page in 1903. The income of this fund
was to be used for kindergarten supplies. It was
then thought that the kindergarten teachers
would continue to be volunteers. The fund was
larger than necessary to furnish the supplies used
and the income accumulated. At this time Mrs.
Frank P. Smith was the chairman of the kinder-
garten committee. Mrs. Smith became convinced
that better work would be done by paid kinder-
garten teachers. In order to try it out, she em-
ployed a paid kindergarten teacher and the better
results were demonstrated. Since this time one
paid teacher has been employed regularly. Volun-
teers have merely supplemented regular work,
and their activity has at all times been under the
direction of the paid teacher.
As the kindergarten work developed and its
value for younger children became apparent, the
need for corresponding work for the older chil-
dren became appreciated. There was need for
diversion to lessen the burden of hospital life to
the convalescent child; there was need also for
systematic instruction to produce the natural
mental development which is the right of child-
hood. At first an extension of correspondingly
interesting and entertaining work, adapted to
the age of the child, was attempted by volunteers.
This work did interest and make the hospital
residence happier for the children, and was to a
certain extent developmental. It did not, how-
ever, meet one sad result of prolonged hospital
stay. We had learned that many children, par-
ticularly difficult orthopedic cases, after a stay of
a month or so in the hospital, fell behind in school
work and, especially if the absence was in the
latter part of the school year, failed to pass into
the next grade. We had learned that such trag-
edies were likely to happen several times in the
education of the same children. The same patho-
logical condition which caused the one hospital
residence often caused others. The result was
that in severe cases, such as bone tuberculosis,
children lost several grades in school, became
older than their classmates and thereby developed
a dread of school attendance that seriously hin-
dered their progress. Many of them dropped out
of school for no other reason than that they had
become ashamed of their grade, ashamed to be
graded with children who were so much younger.
These cripples are the children who, above all
others, should receive education. With an educa-
tion there are many vocations in which a cripple
can excel and many others in which he may suc-
cessfully earn a livelihood and be free like other
people. Without education the life of a cripple
is indeed hard.
This situation was called to the attention of the
Board of Education of Cleveland. The work be-
ing done in the hospital was investigated and ap-
proved, but the fact was recognized that this
work was not meeting the situation — that it did
not prevent the loss of school grades. Interest in
the problem was aroused, and, as there were in
the hospital at all times enough children to oc-
cupy the time of one teacher, the board decided
that these children were entitled to the same edu-
cational facilities as their more fortunate fellows.
A grade teacher was therefore employed to begin
work January 15, 1918. This teacher is a part
of the teaching force of the public schools,
familiar with the grading and the work of each
grade, and familiar with the time of year in
which each topic is taught. She is attempting
to keep up the work of each child so that it may
go back into regular school life without a handi-
cap from long absence. It is too early to state
positively the result of this work, but it now
seems to be working out successfully.
This innovation happened to come at the time
that the board was planning extensions to the
■work of Americanization. A second teacher was
THE MODERN HOSPITAL
355
therefore sent to the hospital from this branch of
the work. It is the duty of this teacher to teach
convalescent men and women to read and to write
the English language. Most of these patients
have had some education in their native land, so
that the task is a much simpler one than teach-
ing a child. Progress is very rapid and the in-
terest in the work shown by the patients is simply
astounding. To see a group of grown men
struggling with the fundamentals of arithmetic,
or writing sentences so simple as to be childish,
is pathetic. It makes one realize that we have
talked too much about the duty of our foreign
population to this country and too little of the
responsibilities of this country to these foreign-
born citizens.
It will be difficult to measure the success of
this work, but we believe that, if the beginnings
of an education to write, read, and speak English
are obtained and the determination to finish the
task aroused, many, if not quite all, will in vari-
ous ways continue their development after leav-
ing the hospital.
The organization of the work is as follows:
The kindergarten teacher formerly employed by
the hospital, Miss Ruth Sencabaugh, had been in
the public schools and became much interested
in the problem. She was taken over by the Board
of Education and made the principal of the hos-
pital school. Tlirough her, proper cases are se-
lected and placed in various classes. She is rec-
ognized as the head of all aducational work in the
hospital, both by the board of education and the
hospital. The teachers ai-e responsible directly
to her. She supervises and is in charge of the
kindergarten work for small childi-en. This is
supported by the hospital to the same extent as
heretofore.
EXTENDING THE INFLUENCE OF A HOSPITAL
Teaching of Diagnosis Made Available to Doctors at the End of the Earth — The Case
Records of the Massachusetts General Hospital a Pioneer in This
Field— Unique Character of the Course
By F. M. painter, Assistant Editor, Case Records of the Massachusetts General Hospital, Boston
iixyEVER have I, in the medical literature that
IN I know," writes a professor of medicine,
"seen anything more original, suggestive, and
practical than this teaching."
"The original method you have developed in
your work," writes another, "has been a great
assistance to me in the course of my teaching."
The unpretentious series of case histories so
surprisingly commended has proved its practical
value even more strikingly to practicing physi-
cians.
!'These sheets," writes one, "are the most valu-
able and informing that come to my desk, and I
look forward to their arrival with intense pleas-
ure and interest."
"The best thing in any one line of medical lit-
erature I have ever received."
"I find them indispensable."
"I feel they are of inestimable value to me.
Just what I have been wanting for years."
"No active physician can get more assistance
from any source."
"I carefully study these at the expense of ne-
glect of my medical journals."
"The most valuable addition to medical litera-
ture and teaching within my knowledge. They
stimulate one to read ... as nothing else
can do."
"Oh, that we had had these Case Records thirty
years ago ! As for me, I should have been a bet-
ter doctor."
"Charge us more, only for God's sake don't
stop them."
The printed sheets in question are merely an
extension of a method of teaching diagnosis,
tested and perfected by ten years of trial before
their existence. In 1905 Dr. Richard Cabot be-
gan discussing clinical histories before weekly
classes of fourth-year students, house officers, and
practicing physicians. Dr. Oscar Richardson read-
ing and commenting on the necropsies, which he
himself performed. Later the surgical cases
were discussed by a surgeon, at first by Dr. Rob-
ert B. Greenough, since 1909 by Dr. Hugh Cabot.
By degrees the system worked out into its pres-
ent fonn. Abstracts of the clinical records of
three or four cases that have come to necropsy
are multigraphed and distributed to the class.
The physician discusses the clinical history and
the differential diagnosis, and makes his own
diagnosis. The surgeon must in addition record
his preoperative diagnosis before the report of
the operation is handed to him. When the clinical
evidence is all in, the discussion as complete as
it can be fi'om that evidence, and the clinician's
diagnosis on record, the pathological findings are
356
THE MODERN HOSPITAL
discussed by Dr. Richardson, and the clinical and
pathological evidence compared.
Obviously two great principles are embodied
in the method, the mental stimulus of suspended
interest, and the test of theory by fact. In the
hands of masters of diagnosis the exercise be-
comes as absorbing as a game. It is skill and
scholarship pitted against the unknown. For the
moment the dingy pathological ampitheater be-
comes a jousting field. At the end of the dis-
cussion there is a moment of tense suspense while
the pathologist, not without a sense of the dra-
matic value of the situation, comes forward to
herald the outcome of the encounter. Defeated
or in laurels, the clinician goes his way — in either
case a better diagnostician by virtue of as rigor-
ous a bit of mental athletics as a man can well
undertake.
This tournament aspect of win-or-lose is, of
course, the most superficial part of the interest
of the exercises. To make a correct diagnosis is
a small part of the value of the study of a case.
Some of the most stimulating discussions deal
with conditions so obscure or data so insuflScient
that positive diagnosis is impossible. It is in the
weighing of the evidence given, the balancing of
possibilities and probabilities, that diagnostic
skill is needed. To the men who attend these
classes their value lies in working under the lead-
ership of an eminent diagnostician on a problem,
even though it is insoluble, and then comparing,
weighing, and tracing relationships between
clinical and post-mortem findings. The exercise
is often most helpful when it means being
"baffled to fight better." From the tilt, any man
may not only add to his knowledge but gain some-
thing of Dr. Cabot's courageous philosophy.
"If I make the diagnosis," he tells his classes,
"I win. If I am wrong, I learn something. Either
way I win."
It is not without interest that this austere
method of discipline by fact should have origi-
nated with, and for twelve years been practiced
by, a man who might well say to his critics, as
Emerson said to Carlyle, "You sometimes charge
me with I know not what sky-blue, sky-void
idealism."
This is the method of teaching diagnosis which
since April, 191-5, the published Case Records of
the Massachusetts General Hospital have been
carrying to thousands of doctors. It is a pioneer
method which has beaten out its trail in an hon-
est and courageous search. The printed sheets
make it possible for the man in Peru, Japan, or
the Philippines to give himself something of the
same training and to taste something of the same
zest of problem-solving that he would have in the
class in Boston. A group of men in a Manitoba
county society or on the staff of an isolated state
hospital can find a much more vital and stimu-
lating contact of minds and far greater practical
benefit in working out such a case together than
in listening to set papers. The arrangement of
the Records makes it possible to follow the
method exactly as is done in the hospital amphi-
theater. The clinical history is printed on a sep-
arate sheet, so that it can be studied quite by it-
self. The discussion, diagnoses, and necropsy
findings are printed not only separately, but, at
the suggestion of a subscriber, on paper of a dif-
ferent color.
"Your Seidlitz powder clinics," a reader calls
them, "i. e., a blue one and a white one, to be
mixed and taken while effervescing. . . . Allow
me to say that these Records are an aid past all
description to the isolated man, and I regret past
telling that I have only of late subscribed. The
beauty of the Records lies in their honesty. Long
may they wave !"
It will, I think, be clear why subscribers write
with so striking a ring of personal feeling. These
are not merely readers. They are members of a
class.
"To a great many of us," writes one, "these
cases are the only post-graduate work we have
at the present time."
"It awakens the interest of the reader," writes
a South American, "associates him, so to speak,
with the case under discussion."
There is no question but this sense of being
present in a class or at a consultation is greatly
enhanced by the excellent, almost verbatim re-
ports which are now being published, giving the
rapid-fire back-and-forth discussion of the doc-
tors and the questionings of the students; a tri-
umph of medical reporting, the most difl!icult
branch of stenography known. This has been a
comparatively recent outgrowth, like the half-
tone reproductions of Mr. Brown's beautiful
photographs and photomicrographs of specimens
which have lately been added to the X-ray illus-
trations published since the second year. From
the beginning, however, the effort has been to
give the man at a distance a voice in the pro-
ceedings. Early in the history of the publication
a circular was sent out asking for criticisms and
suggestions as to ways in which the Records could
be made more helpful, and the ideas in several
hundred replies were carried out as far as was
practicable. For three years every subscriber
who let his subscription lapse was asked to give
his reasons, in order that the Records might be
improved. The addition of a certain number of
cases with recovery, emphasizing therapeutics,
THE MODERN HOSPITAL
357
was made in response to many requests. The ex-
cellent system of numbering now in use, by which
the number of each Record shows the date of its
issue, was the ingenious idea of a subscriber.
From time to time questions have been demo-
cratically put to vote, and ballots sent out to be
filled in. Shall more or fewer cases emphasizing
treatment be included? Will a reduction in the
number of cases issued weekly be satisfactory, as
a matter of war-time economy?
The personnel of the voters replying has repre-
sented every rank of the profession, from the vil-
lage doctor and the recent graduate to the pro-
fessor in a leading medical school and the intern-
ist of national reputation. It has been in such
replies to requests for criticisms or preferences,
or in letters accompanying checks, that the many
expressions of approval have been sent, a few of
which I have quoted. If the large body of sub-
scribers scattered over half the world shows
something of the spirit of an enthusiastic and
friendly graduate class, it is not a mere chance,
but the result of a definite policy.
The distribution of this class is interesting.
There is not a state or territory in the Union
but is represented on the subscription list. Yet,
though the most sparsely settled western states
all have a showing — Montana, for example, with
only a few more inhabitants than Buffalo, has
fourteen subscribers, and Arizona, with not many
more than Providence, has six — still it is the
most progressive states which subscribe most
largely. Not without honor in its own country,
the series finds its longest state subscription list
in Massachusetts. The next in order are those of
Pennsylvania, New York, Illinois, and California.
Taking the countiy in sections, the largest num-
ber of subscriptions are in the states north of the
Potomac and east of the Ohio, the next largest in
the Middle West, which has almost as many as
the western and the southwestern sections to-
gether. Besides these, there are a considerable
number of Canadians, a small representation of
Mexicans, South Americans, West Indians, and
Phillipine Islanders, and one reader in Japan.
Among these widely scattered subscribers are
fifty-seven hospitals, including one naval hospital
ship ; eleven medical libraries, including the
Surgeon General's and those of Boston and New
York; five insurance companies, four city health
depai'tments, and several great employers. Per-
haps the most significant item on the whole list,
however, is the subscription of the Surgeon Gen-
eral of the Army, which has several times been
added to, and was recently increased from 216
copies to 481.
The inherent value of the teaching method has
been shown by its adoption and successful pur-
suit elsewhere. A class conducted along the same
lines as Dr. Cabot's by the visiting physicians of
the West Medical Service, Dr. William 11. Smith
and Dr. Roger I. Lee, with Dr. Richardson, has
flourished since 1905, and has gi'own even under
the adverse conditions of war times. Dr. Jane-
way put the idea into effect in clinics at Johns
Hopkins, and until a short time before his death
carried on a regular exchange of papers with Dr.
Cabot. When the latter followed his brother into
war service in France in July, 1917, leaving the
discussion of cases lor the published series to Dr.
Smith and Dr. Edward L. Young, Jr., both the
substitutes modestly said, "It is the personality of
the Cabots that has given this thing its vitality."
Yet in spite of the shock of war conditions the
series is showing each month a growing subscrip-
tion list, although it has had almost no advertis-
ing, as that is understood by the great publishers.
It has two great elements of strength. It is a
wholly honest submitting to the teaching of fact ;
and it has the gift of the gods of being inter-
esting.
Incidentally the Records show a pleasant pic-
ture of professional team work. It is an admir-
able sight, and too rare, when a physician, a sur-
geon, and a pathologist, representing among
them not a little fieiy and imperious tempera-
ment, meet weekly for twelve years and harmo-
niously compare their widely differing points of
view. If the series did no more than exhibit to
the world the spectacle of these various special-
ists peacefully "grazing as one," it would not have
existed in vain.
To carry not so much certain teaching as the
class and the hospital itself to the isolated or the
busy man ; to take to him in applied form the
newest and best in diagnostic and therapeutic
method, with concrete example of its working; to
help the varying needs of the practitioner in his
practice and the teacher in his teaching; to jog
the elbow each week, while books and quarterlies
tend to become shelved or buried ; and to do these
things at a price so low that many subscribers
have written they would rather double it than
receive fewer cases; this is the unique function
of Dr. Cabot's series. Other "clinics" bearing
long lists of notable names and pushed by all the
machinery of commercial enterprise have fol-
lowed the pioneer. Yet the Records combine
advantages which give them a place not filled by
anything else in medical literature.
For everything we do or leave undone we must sooner
or later pay the bill, and we should take this into account
before we give our orders to fate. — Ellen Thorneycroft
Fowler.
358
THE MODERN HOSPITAL
THE COUNTY JAILS OF ILLINOIS
The Disgrace of the State— Factors in the Promotion of Crime and Dedeneracy, and
Failures in the Protection of Society— New Laws Eliminating
Worst Features of Old System
By ANNIE HINRICHSEN, Executive Secretary, Illinois State Welfare Commission, Springfield, III.
THE county jails of Illinois are admitted to be
the disgrace of the state. They were estab-
lished for the reformation of offenders, the pro-
tection of society, and as deterrents from crime.
They have not fulfilled any of the purposes for
which they were created. On the contrary, they
have proved powerful factors in the promotion of
crime and degeneracy.
Fig. 1. The cell block ot the old Pei
Not one voice is raised in the defense of the
county jail. There can not be found in Illinois
any official who will declare that the county jail
as it is today is of the slightest benefit to a com-
munity.
And yet, so securely are they bulwarked by
ancient prejudice that they stand impregnable
before the attacks of practical reform and social
justice. They are the definite ex-
pression of the public attitude to-
ward the alleged law-breaker.
They state in terms of stone and
steel, darkness and hunger, that,
for the man accused of crime,
Illinois knows no justice. They
state in terms of dollars and cents
that the tax-payers support, at
heavy expense, a factory whose
only output is crime and disease.
The first official survey of the
Illinois jails was made in 1870 by
the newly created State Board of
Charities. The report of this sur-
vey is a tale of horrors. The jails
are denounced as filthy dungeons
unfit for human habitation. The
methods of care of the prisoners
are pronounced inhuman and in-
efi'ective.
This survey resulted in a new
jail law. This law, practically
unchanged, is the one under which
the jails are, nominally, operated.
It requires the sheriff to furnish
the prisoners with abundant food,
plenty of water for drinking and
bathing, to keep the jail clean and
sanitary, to provide certain toilet
facilities, and to separate the dif-
ferent classes of prisoners.
Nearly every year since 1870,
the state has inspected the jails.
The last report, published in 1916,
differs little from the report pub-
lished in 1870. Many of the same
jails are in use, and the method
of operating them has not changed.
Five-sixths of the jails are today
just what they were fifty years
ago — black dungeons into which
THE MODERN HOSPITAL
359
air and sunlight can not penetrate, filthy with
vermin, disease, and the accumulated odors of the
fetid air of many years.
The jail law is ignored in nearly every county.
When, as inspector of institutions for the State
Charities Commission, I visited every county jail
in the state in the year 1915, I found that only a
small minority of the sheriffs had read the state
jail law. Many of them had never heard of it
and did not know there was one on the statutes.
Those who had read it and conscientiously wished
to observe it were unable to do so
on account of the construction of
the jails. The most important
section of the law, the one requir-
ing separation of different classes
of prisoners, could not be enforced
in a building which had been
erected for a dozen prisoners and
in which fifty must now be held.
A new jail is the last institu-
tion which even the most enlight-
ened community is willing to erect.
Public sentiment does not regard
the jail problem as among those
requiring social discrimination.
The majority of the jails are
more than fifty years old. Sev-
eral were built seventy-five or
eighty years ago, and two, the
boast of their counties, were in use
before Illinois became a state.
There are three kinds of archi-
tecture in our Illinois jails: the
basement jail, the stone-block jail,
and the iron-cage jail.
The basement jails are several
feet under ground. Air and light
can not enter; rats, vermin, and
sewage seepage do. The walls and
floors are wet, frequently with
sewage seepage.
The stone-block jail is a block
of stone or brick built in the cen-
ter of a large room. In its sides
are small, dark caves, so small
and dark that they appear as black
shadows against the block's sur-
face. These caves are the cells in
which the men live.
The iron-cage jail is a barred
room built in a larger room. The
iron cage contains cells of bars or
solid iron. These are the so-
called more modern jails, and
some of them are light and well
ventilated. When the cage is built in line with
the windows of the room and the windows are
opposite the barred open spaces, there may be
light and air.
The furnishings of the jail depend upon the
generosity of the county board and the insistence
of the sheriff. The beds are usually steel wall cots
and canvas hammocks with blankets for cover-
ings. A few of the jails have good mattresses,
sheets, and pillowcases.
The toilet facilities may be shower baths and
enter. Will these cells refo
360
THE MODERN HOSPITAL
modern plumbing; they may be a few tin cans
and a metal laundry tub, in which twenty men
wash their bodies and their clothes.
In the southern counties we find fewer toilet
facilities. Here we find the metal laundry tub
with all its horrors. This tub is the only bathing
convenience provided. In it men wash their
bodies and their clothes. Sick men and healthy
men bathe in it ; sometimes twenty men must use
this one tub. The water, heated on the jail stove,
must be carried to it ; for there are no water and
sewage pipes in the jail. The common towel may
be in use, or one may be shared by three, four.
^MWPIWW
... . ,f\\,.,.
' * * ' * — '*;V» ■ n fl t >u«.
Fig. 3. I'erforated shoct
indows instead of glass.
or more men. The towels are washed, if washed
at all, by the prisoners themselves. They do not
receive the germicidal benefits of sunshine and
steain.
The buckets are sometimes substantial ones
with tightly fitting covers; sometimes they are
battered tin pails which have seen service else-
where ; again, they are tin vegetable cans.
The methods of sewage disposal can be recog-
nized half a block away. In central and northern
Illinois we find slightly improved toilet and sani-
tary facilities, and, when least expected, a jail
which is unfit for a human being to enter.
The prisoners are held in complete idleness.
The law provides for work, but no systematic
effort has ever been made to put the law into
effect. A small number of the men work around
the jail ; their efforts, however, are hardly more
than perfunctory. Occasionally a sheriff has set
his men to painting and yard and street cleaning.
Again we find public sentiment against a better
jail system. In several counties strong pressure
has been brought to bear to prevent the labor of
the prisoners, the claim being made that work is
being taken from worthy persons to benefit law-
breakers. In spite of the scarcity of labor and
the abundance of work, this claim is being con-
sidered and few county officials have disre-
garded it.
In six county jails men and women occupy
adjoining cells in the same room.
There are seven detention homes in the state,
and, in ninety-five counties in which there are no
detention homes for juvenile offenders, the chil-
dren are held in the same jail with the adult
prisoners. In two-thirds of the counties the boys
are kept in the same rooms, frequently in the
same cells, with the older offenders. Girls of
fifteen and sixteen, arrested for the first time,
are found in rooms with the most depraved
women of the streets.
Physical examinations upon entrance are made
in only three jails, and in the others, the prison-
ers are herded together regardless of disease.
The county boards allow the sheriffs "per-
diem" fees for the food of their prisoners in the
county jails in all counties in Illinois except
Cook, St. Clair, and Rock Island. These fees
vary from thirty cents a day in Sangamon and
Macon counties to $1.25 a day in Brown county.
Fifty cents is the average.
The great evils of this system are the under-
feeding of the prisoners, the number of unneces-
sary arrests and the development of the bitter
antisocial spirit in the prisoner. The sheriff
naturally expects to make a profit on the food of
the prisoners. From the earliest days of jails and
THE MODERN HOSPITAL
361
sheriffs, the sheriffs have expected to make a
profit on their prisoners' diet. The extent of the
profit may depend upon the sheriff's kindness of
heart more than upon his sense of honesty.
The larger the number of prisoners, the greater
will be the profits, and, consequently, the jails
must be well filled. This circumstance has for
so long been recognized as a matter of course
that the sheriff who keeps his jail well filled is not
regarded as a vigilant oflicer of the law as much
as he is regarded as a thrifty business man.
The greatest evil of this vicious fee system is
the effect on the prisoner. The prisoner knows
what the sheriff receives for his food ; he knows
that the sheriff receives fifty cents a day and
gives him ten cents worth of food ;
he knows that the sheriff is using
his degration as a means of filling
his own pockets ; he knows that
the sheriff, as an officer of the law,
is using his prisoners' degradation
and his own office as a means of
law violation for personal gain,
and is protected in his law viola-
tions by the very law that he is
sworn to enforce. This knowledge
develops in the prisoner a hatred
and a contempt for a law admin-
istered with the grossest injustice,
and this hatred and contempt of
the law find expression in greater
crime.
If any one doubts this state-
ment, or would modify it, let him
go into the jails of Illinois and
talk to the prisoners, to the re-
peaters, to the men who are serv-
ing, or have serv'ed, penitentiary'
sentences after one or more terms
in the county jails.
This antisocial attitude among
prisoners and ex-prisoners is a
definite condition. Its terrible
strength is shown in the histories
of the men who repeatedly violate
the laws, who come again and
again into the courts. We do not
assert that it is one of the chief
contributing causes of crime, but
we do claim that it is one cause,
and one for which we can place
definite responsibility.
The jail is not a strong-box for
holding desperate criminals. Des-
perate criminals constitute only a
very small percentage of the jail
population. The jail inmates are
petty offenders and persons too
poor to pay fines or provide bail. Jail sentences
are imposed for misdemeanors and failure or
inability to pay fines. Murder and treason are
the only unbailable offenses. Consequently,
nearly every person charged with crime may, if
he has money or friends, have his freedom until
conviction.
The prisoner may remain in jail for as long a
period as two years. Cases may be continued
through many terms of court, and prisoners may
remain in jail for a year before trial and for as
long as a year thereafter to serve sentence.
The statement was made in a preceding para-
graph that the jails of Illinois are a powerful
factor in the promotion of crime and degeneracy.
362
THE MODERN HOSPITAL
I have attempted to develop this statement in
detail. In summing up the developing para-
graphs, I present the following reasons for my
statement (1) their physical construction; (2)
their method of operation; (3) their enforced
idleness of prisoners; (4) the fee system of
feeding.
1. The physical construction of the jails is
such that they are insanitary, ill-ventilated, dark,
and too small or too poorly planned to permit of
Fig. 5. This pretentious building is the sheriff's residence. The annex
jail, a typical form of jail architecture.
the classification of prisoners, or of the separa-
tion of the healthy from the sick. The health of
the men must suffer; communicable diseases are
certain to be passed around among them. The
lack of fresh air, exercise and stimulating inter-
ests makes the prisoners particularly susceptible
to disease, both physical and mental. The herd-
ing together of all classes, regardless of age and
degree of crime, spreads a moral contagion
through the jail; and, as with the physical con-
tagion, there are no counteracting influences.
2. The method of operation may make even a
modem jail vilely insanitary. Clogged air shafts,
disabled plumbing, filthy bedding, the common
towel and drinking cup, the tub in which all must
bathe, the lack of steam and sunshine for towels
and bedding, the closed and grimy windows, the
presence of rats and vermin, failure on the part
of the sheriff" to enforce the classification law —
these conditions can make, and in certain in-
stances have made, even the better jails as dan-
gerous as the worst. On the other hand, several
very poorly constructed jails are made habitable
by the determination of the sheriff to eliminate
as many evils as possible.
3. The enforced idleness predisposes the pris-
oner to every kind of moral, mental and physical
contagion.
4. The fee system of feeding, long recognized
as a legitimate source of profit for the sheriff,
proves to be a means of rousing in the prisoner a
contempt for the law; it sends him forth from
the jail a greater enemy to society than he was
when he entered it, and more fully
prepared for a career of crime.
Physically, mentally and moral-
ly, the men go forth worse than
they were when they entered, and
they go forth hating the travesties
called laws which have been re-
peatedly violated by the officials in
their efforts to punish them.
For many years the State Board
of Charities and its successor, the
State Charities Commission, de-
manded better jails and a system
which would eliminate the jail
except as a place of temporary de-
tention of persons waiting trial.
A demand for a new jail brings
as effective results as are brought
by beating with bare hands against
a granite wall. A demand for a
new jail system has been satis-
factorily answered by the last
jt the rear is the General Assembly.
The State Charities Commission
asked for two laws which will materially decrease
the jail population and eliminate several of the
worst features of the jail problem.
We asked for a state work farm and the aboli-
tion of the fee system of feeding prisoners. The
bills were passed.
Several of the states have established work
faiTTis for petty offenders and these farms have
proved a means of solving a part of the jail prob-
lem. The men work in the open air, the classes
of offenders are separated, and the "per-diem"
fee system of feeding is not used.
With little opposition a bill was passed author-
izing the Department of Public Welfare to estab-
lish a work farm for offenders over the age of
sixteen years who would serve sentences of sixty
days or over in the county jails. The plans for
the work farm are now being made by the depart-
ment.
The bill abolishing the fees to sheriflfs for the
food of the prisoners proved a difficult one. It
required the sheriffs to buy the food, to hire it
prepared, and to present itemized bills to the
THE MODERN HOSPITAL
363
county board. The law was not to go into effect
until December, 1918, when the new sheriffs take
office.
It was predicted that this bill could never be
passed, and a powerful lobby was organized to
defeat it. It was denounced as anarchistic, ultra-
radical, maudlin, and a deliberate rebuke of the
present sheriffs. On the other hand, many of the
most influential members of the house and .senate
the dungeons many of their worst evils. They
will not be overcrowded. The prisoners will not
be herded together regardless of age, nature of
crime, or physical condition; men will not serve
sentences in idleness surrounded by the most
vicious influences ; they will not be fed, or under-
fed, for official profit.
Public sentiment, as expressed by the General
Assembly, is in iavtiv of an cnliirhtciicd svstem.
strongly favored it, and several sheriffs urged its
passage.
It passed the house by barely enough votes to
carry it to the senate. When it was first voted
on in the senate it was defeated; the following
day, however, it was called up for reconsidera-
tion, and, after one of the liveliest debates of the
session, it received enough votes for its passage.
It was among the first of the bills signed by
Governor Lowden.
The removal of the sentenced prisoners will
decrease the jail population and make possible
better sanitary facilities. It will also enable the
sheriff to separate the different classes of pris-
oners.
The change in the method of feeding prisoners
will further decrease the jail population by de-
creasing the number of arrests. There will be
no incentive to the sheriff to underfeed his men ;
and the prisoners wifl not be exploited for finan-
cial gain.
The ancient dungeons of Illinois will not be
erased from our map for many years. But the
old system has yielded to fifty years' bombard-
ment, and the change of systems will take from
And it is not too much to hope that this senti-
ment may eventually include the time-dishonored
bastiles and drive these relics of barbarism from
the state.
Progressive Social Service Legislation in Saskatchewan
Progressive legislation has been one of the things for
which western Canada has been famous these many years,
but nothing so radical has yet been passed as the recently
proposed law, making it a punishable offense for
anyone suffering from social diseases to marry. That
such a law will undoubtedly be passed at the next session
of the legislature is predicted in a statement issued by
the Saskatchewan Social Service Council, which has been
exceedingly active in work of this kind, and which has re-
ceived assurances from the government that something
of this nature will be taken up. A year ago the Sas-
katchewan government took action in advance of the re-
cent decision of the United States Government establish-
ing anti-vice zones around army and war work centers,
and passed a law making failure to report to the pro-
vincial health authorities all cases of this kind, an of-
fence punishable with severe penalties.
It is expected that under the law which is now contem-
plated a government certificate of mental and physical fit-
ness will be required before marriage may take place,
and those who are acquainted with the processes of the
law in Canada declare that such a statute will be rigidly
enforced.
364
THE MODERN HOSPITAL
INSTITUTIONS FOR THE CARE OF EPILEPTICS^
Selecting the Proper Location -Why Patients Should Have Employment -As to tht
Proper Size of a Colony— How to Construct Cottages— Arrangement for
Employees Studying Individual Needs of Patients— How to
Provide Instruction and Proper Medical Care
By WILLIAM T. SHANAHAN, M.D., Medical Superintendent, Craig Colony for Epileptics, Sonyea, N. Y.
THIS subject is one which, during recent years,
has received much attention. When select-
ing a site for a colony or village for epileptics,
careful consideration must first be given the fol-
lowing: an abundant, accessible, sanitary supply
of water, not too hard; the safe disposal of sew-
age; soil of such quality that the larger part of
the site can be tilled as the colony develops; a
topography providing natural means for separat-
ing the sexes and also the mental grades, and
permitting the carrying out of landscape garden-
ing with proper layout of roads, walks, trees,
shrubs, etc. ; adequate rail facilities for receiving
supplies and for ingress and egress of residents
of the colony and of visitors ; and in addition,
proper highway facilities about premises and to
near-by villages and cities. The institution
should be reasonably near a city or large village,
so as to provide means for employees to secure
recreation when off duty. The site should con-
tain tracts available for the erection of buildings
without necessitating a great amount of pi'elimin-
ary grading. Whenever possible, the heating
and lighting plant should be centrally located, so
as to avoid the additional cost of maintenance
and extra labor entailed in consequence of multi-
ple plants.
The first patients to be admitted should be those
epileptics physically capable, barring an oc-
casional seizure, of working regularly and re-
quiring the least supervision. If at the outset
patients are admitted irrespective of their physi-
cal or mental disability or of both, it will be diffi-
cult with such a handicap to develop the institu-
tion properly during the early days of its ex-
istence when every bit of energy that can be
secured should be utilized for constructive pur-
poses.
Only after the essentials have been well started
and proper accommodations provided for workers
and neces.sary help, should the admission of the
more marked mentally and physically disabled
epileptics be given favorable consideration. The
•This paper is the fifth in a series, by various a
classes of special hospitals. The first, "Standards fo
Hospital." by StafTord McLean, appeared in May; the
Standards of Hospital Education for Interns," by J.
June : the third, "The Standardization of Hospitals for the Insane/' by
William C. Sandy, in July ; the fourth, "Standardization of State
Hospitals." by A. L. Bowcn, in August.
Children's
:ond, "The
Baldy,
colony will grow toward completion more satis-
factorily if this one idea is borne in mind. One
of the greatest problems institutions have to con-
tend with is the providing of proper care and
supervision for those of its inmates who are
markedly defective mentally.
A conservative estimate is that at least one in
five hundred of the general population is epileptic.
Of this number about 25 percent may apply for
admission to a state colony.
Of the epileptics ordinarily seen in our institu-
tions, the majority exhibit some mental abnor-
mality, the degree of which varies in different
individuals and also from time to time in the
partic-dai. individual. Some, during the inter-
paroxysmal period, show practically no evidence
of their affliction. Many, however, have recur-
ring periods of mental disturbance, lasting in
some for hours, in others for days or weeks, after
which they clear up. Not infrequently a progres-
sive mental deterioration goes hand in hand with
such recurring periods. Epilepsy and primary
feeble-mindedness, when associated, are but con-
comitant signs of a defective make-up. Because
of these various phases of mental instability and
the associated convulsions, an institution for the
care of a considerable number of epileptics should,
when possible, be so planned that proper pro-
vision can be made for afl types, irrespective of
their mental condition. When sufficient land is
available, at least one acre per patient, there
should be no difficulty in so grouping the build-
ings as to provide sufficient separation of the dif-
ferent mental grades.
As to the ultimate size of a colony, there has
been much discussion along both theoretical and
practical lines. Ordinarily the institution having
capacity for five hundred patients can have a rea-
sonable variety of occupational and recreational
activities for therapeusis, can maintain various
industries of a value toward lessening net cost
of maintenance, and can provide facilities for
satisfactory classification and scientific care and
treatment, under the guidance of an executive
who can have a close personal and intimate
familiarity with the operation of the colony and
an acquaintance with its inmates. In an institu-
THE MODERN HOSPITAL
365
tion with two or three times this population, the
superintendent must perforce have a less direct
relation to the various phases of institutional
activities. As to economical administration, there
is probably nothing gained after an institution
passes a capacity of perhaps a thousand inmates.
The average epileptic in a colony can be allowed
entire liberty about the premises and various
privileges consistent with the mental status of the
individual. Serious quarrels or infractions of
rules are not more frequent than in an ordinary
village for the same population.
The plea is often made that the presence of
the insane and the lower-grade epileptics has a
depressing effect on the other patients and deters
many from entering the special institution. If
the structures for the more deficient type are
placed at some distance from those for the
brighter class, and partly or completely hidden
from view by trees or elevations of land, there
can be no serious objection to having all types
in one institution.
The epileptic, being subject to a mental or
physical incapacity which may be either partial
or complete, transitory or permanent, very often
is in consequence barred from remunerative em-
ployment in the outside world, thus becoming a
dependent on his family or the community. In
the home he is a constant source of sorrow and
anxiety, and in institutions planned to care for
other types of defectives he is a disturbing ele-
ment because of his recurring seizures.
The village idea, with varied but harmonious
types of architecture, should be ever foremost in
the development of a colony so that the stamp
of the institution may be as much in the back-
ground as possible. Preceding the inauguration
of the colony development, quite complete plans
as to its ultimate size, arrangement of groups,
etc., should be carefully formulated, but these
plans should not be so fixed that the benefits of
experience cannot be applied as the colony passes
througJi its different stages of growth.
Difficulties encountered by hospitals in obtain-
ing funds for development are common, but oft-
times there are special troubles besetting state
institutions, owing to lack of full first-hand in-
formation by the appropriating bodies of actual
requirements and the purposes of the particular
institution. Plans for progressive development
may be delayed for many, many years because of
lack of adequate funds.
Proper classification of patients is of the ut-
most impoi-tance, not only for care and treatment,
but also for scientific research. The smaller the
cottages and the nearer they approach a home.
the greater the success in classifying and the
more nearly the structure affords contentment for
its residents. The furnishings should be simple
but ample.
The best type of building for a colony for
epileptics is the one or two-story cottage, simple
but attractive in design, those for the brighter
patients accommodating not more than from
fifteen to thirty-five and the cottages for lower
mental grades somewhat larger; but under no
circumstances should a single structure be erected
to accommodate more than seventy-five. The
per capita cost of maintenance in the small cot-
tage with its close approach to home life is prac-
tically the same as in the large structure where
this important phase is lacking. Where stair-
ways are necessary, they should have a gradual
ascent, having broad treads, low risers, high rail-
ings and round corners. The flights should be
broken by frequent landings. The fewer the stair-
ways the smaller the number of injuries, the
easier it is to get the patients out of (^ ':z, and
the greater the ease of supervision. Ramps may
be used to advantage in place of stairs. For ease
of supervision, egress of inmates and simplicity,
the one-story structure for the more helpless
types is to be preferred.
The cottages may be erected of frame, con-
crete, brick, or stone, insuring a little variety to
the structural plan of the community. Cottages
should not be too ornate and of exceedingly costly
construction, nor, on the other hand, should false
economic methods demand that they be so cheaply
built that constant repairs will be required to
keep them in habitable condition. The cost per
capita will necessarily vary somewhat with the
site of the colony, but in no instance should com-
mon-sense methods be lost to view.
Separate gi'oups, each with its central kitchen
and dining-room or separate dining-rooms for the
smaller cottages, should be arranged for proper
classification, somewhat after the following plan :
1. The administrative group, centrally located
and providing for executive building; accommo-
dations for physicians and other officers, cottages
being provided for those who are married ; hos-
pital properly equipped to care for acute surgical
and medical cases ; reception cottage ; assembly
hall ; school ; field for outdoor sports ; laboratory
for research work and a chapel. Opportunity for
attendance at chapel senices on Sunday makes
for contentment and is a feature of the village
plan.
2. A group of industrial buildings, including
laundry, and various shops, should also be located
so as to be readilv accessible. The central store
366
THE MODERN HOSPITAL
house foi- food, clothing, household supplies, etc.,
should have alongside it a railroad switch as
should also the central heating and power plant.
There should be facilities for unloading and stor-
ing coal sufficient for use over an extended period.
3. The colony should be divided into two prin-
cipal parts for the sexes and then each of these
two groups subdivided as follows: (a) group for
the better mental grade of colonists; (b) group
for middle grade, many of whom are good work-
ers; (c) group for insane epileptics, provision
being made for both the acute recurring cases and
the chronic cases; (d) isolation cottages for the
tuberculous and for those having contagious dis-
eases; (e) infirmary group, with adequate sick
wards, for the low-grade idle patients; (f) for
males, one or more farm colonies.
In the cottages for the acutely ill, which
naturally includes those in a disturbed mental
state, and in the small cottages for the brighter
class, there should be a few rooms for but one
patient each, but, as a rule, small wards are to
be preferred to single rooms. In the ward, better
supervision is possible both by attendants and
by fellow epileptics, whose assistance should al-
ways be available.
There should be ample day or living-room space
in all cottages, an abundance of windows furnish-
ing ventilation and light, and adequate bathing
facilities, showers being preferred to tubs. The
smallest possible amount of construction to af-
ford opportunity for injuries during seizures is an
essential which must not be overlooked. All cor-
ners and projections should be rounded. Toilet
rooms should have the water closets exposed so
as to permit proper supervision, slate partitions
and doors on individual sections being entirely
out of place. All plumbing should be simple in
style and readily accessible for replacing. Build-
ings easy of ingress and egress are ideal for any
class of defectives but especially for the epileptic,
subject as he is to disturbances of consciousness.
All radiators, cookstoves, machinery, etc., must
be carefully provided with proper guards. All
steam and hot-water risers and radiators must
be covered or the latter must be placed high on
the wall. Indirect heating is desirable if funds
are available to permit of installation.
The number of employees to be placed in the
immediate care of the patients depends on the
tj'pe of patients. A ratio of one attendant to
fifteen patients is sufficient for the workers. For
those physically or mentally impaired, or both,
twice the number of nurses and attendants should
be provided. Employees, especially the nursing
force, must be given comfortable quarters when
off duty. Their labors are such that this is man-
datory. They should be liberally ti-eated as to
hours of duty, recreation, annual vacation with
pay, medical attention if ill, etc.
The arrangement for housing help necessary
to be kept on premises is an entirely different
problem from that which confronts the average
institution in a city. In the colony with ample
acreage, individual cottages, or bungalows for
married heads of departments and certain other
employees must be had, as practically all such em-
ployees must be kept on premises of an isolated
colony, so they may have normal family life. In
an isolated community, such as an institution of
the type under consideration, there must be main-
tained a police and fire organization. Even in
fireproof structures a liberal installation of fire
risers with sufficient hose to cover all floor space
and plenty of hand extinguishers, with the use
of which all employees should be familiar, are
the best means of protection against fire. Facili-
ties of this nature enable prompt combatting of
fire in its earliest stages. Hose carts, hook and
ladder trucks, chemical engine and other pieces
of portable apparatus are of value, but, owing to
time which must elapse before they can be put
in operation, they cannot compare with the fixed
hose reels and hand extinguishers for prompt
action. Regular drills must be had in the
use of such protective apparatus, as well as drills
for patients in rapidly leaving buildings in an
orderly manner. It goes almost without saying
that telephonic communication should be ample,
its lines and those for carrying electric power for
lighting and power being in conduits in and out
of doors, when funds permit.
The patients should be divided into the volun-
tary and the legally or judicially committed.
Many of those sent to a colony should be kept
there indefinitely, both for their own good and
for that of the public. The colony authorities
should also have power to secure the judicial com-
mitment of those whose mental condition deteri-
orating precludes their residing outside of an
institution.
Epileptics who are primarily defective to a
marked degree or who are much demented will
not ordinarily improve materially as a result of
colony treatment. The average epileptic does,
however, after a residence of several months,
show more or less improvement, in regard both
to his epilepsy and to his general health as well,
some having a complete cessation of seizures.
The occupations oflfered the colonists should
be most varied. There is no good reason why
the epileptic whose mentality is not too low should
THE MODERN HOSPITAL
367
not, under proper direction, pursue any ordinury
avocation barring one which would place him in
situations dangerous to him because of his
seizures. Work is especially valuable as a means
of treatment, as carefully regulated occupation
seems to lessen ofttimes the number of seizures
and prevent mental deterioration. The type of
employment should, if possible, prove interesting,
and in many cases must be of a character differ-
ent from that pursued previous to admission to
the colony.
The most valuable form of labor, both from the
standpoint of treatment and from that of mone-
taiy return to the colony, is perhaps out-of-door
work in the garden and on the farm, with their
diversified interests including forestry, breeding
and raising of live stock. After that in import-
ance comes the work in the shops, household,
laundry, sewing rooms, etc. If sufficient suitable
land and equipment are available, there is no
good reason why all vegetables and milk required,
and a considerable portion of the meat, eggs,
fruit, etc., cannot be raised on the colony prem-
ises. A considerable proportion of repairs and
minor improvements can be done, largely by
patient labor, and many articles, such as mats,
rugs, brushes, brooms, vvillow baskets, mattresses,
clothing, stockings, caps, hats, etc., made by the
colonists. The making of soap, printing and
binding, caning chairs and other activities can
easily be carried on. As the institution grows, the
industrial work can be progressively developed.
Local conditions may permit special industries,
for instance, brick and tile-making, forestry, but-
ter and cheese-making, etc.
The earning capacity of the epileptic, as a class,
has been overestimated by many of the general
public, and even by some more familiar with the
special care of such unfortunates. The very
word "defectives" should imply that one should
not expect a community of defectives to be self-
supporting. Of the total number of epileptics in
the average state colony, about 50 per cent are
capable of doing labor of some kind and from
10 percent to 15 percent can perform considerable
work when not incapacitated in consequence of
seizures.
Recreation and occupation are closely related
to the general medical work. Conscientious heads
of departments, sympathetic in nature, should be
appointed so that it will always be evident that
the diversions are therapeutic measures primarily
and for entertainment secondarily and that in-
dustrial departments are for monetaiy return
less than for therapeutic value.
School instruction, both manual and scholastic.
must be had for the younger colonists. A band
and orchestra of patients should exist for the
benefit of the patients who are members, and for
use at dances, band concerts, etc., thus affording
pleasure to the entire resident population. Vari-
ous games and sports, both in-door and out-door,
should be encouraged for self-evident reasons.
Systematized occupation, regular hours, se-
lected diet, hygienic life (of prime importance in
the treatment), can best be carried out in the
properly designed and arranged special colony
where every action, if need be, can be regulated
to meet the indications of the individual. Habits
of personal discipline and self-control are incul-
cated so that the patient of average mentality is
enabled to cooperate better in the plan outlined
for his treatment.
A state institution must perforce expect to pi'o-
vide the common necessities of life without the
luxuries which a private, well endowed institution
would be in a position to furnish its inmates. In
judging a state institution's standards, this fact
must be ever foremost in the mind of the exam-
iner. Pi'oper housing, food, clothing, medical and
nursing care, sensible hygienic methods as to
bathing, recreation, etc., withal reasonable op-
portunities for relatives and friends to visit
patients and the assignment so far as means per-
mit of compatible patients in each cottage, are
demands which should be met. The proper care
of inmates should not, however, be based solely on
economy. The best care in the proper sense is
most economical. Liberal rules regarding visit-
ors make for contentment and show the public
that the work of the institution is for all.
A reception cottage, properly arranged and
equipped, to which is assigned a sufficient nursing
force under the direction of an experienced mem-
ber of the resident medical staff, is of prime value
in the organization. This should be the portal of
entry where, based upon scientific observation
coupled with common sense, is made the classifi-
cation upon which all subsequent care and treat-
ment are continued. For clinical research and
laboratory investigation, various initial examina-
tions and tests can be applied to ascertain leads to
future efforts. The resident physicians assigned
to this work should be practical in their methods
and inculcate similar views in the nursing force.
Close application to the study of the recent arrival
is necessary to bring about his proper readjust-
ment to his new and ofttimes strange environ-
ment. He may never have previously seen an-
other epileptic having a seizure, never have been
under discipline, and prior to his coming to the
colony, he may have been heavily dosed with seda-
368
THE MODERN HOSPITAL
tives, harshly treated perhaps for incidents result-
ing from his disorder and deprived of the broad
perspective of what his condition is and what he
himself must do and accept if an improvement is
to be sought. Persistent effort in direct relation
with the patient on the part of the physician and
nurse must be had to enable the newcomer to
successfully pass through this early and all-
important phase of colony life. The colony or
village with a well-working plan for this situation
deserves a high rating.
The work done in a state institution should
never be spectacular or sensational in character
nor should the curriculum of its training school
for nurses be too erudite to prove impractical.
The physician must spend the greater part of his
time in the cottage and ward with his patients
if he is to have a proper perspective of the dis-
order he is studying and seeking to alleviate. A
minimum of ordinary office desk labor and a maxi-
mum of clinical observation should be the points
on which judgment is passed as to the medical
work of a state colony.
POINTS ON WHICH TO BASE STANDARDIZATION
For self-evident reasons the standardization of
special state institutions for epileptics is not as
readily obtainable as is the standardization of
general hospitals. For comparison, however, the
following headings might be considered :
Medical Staff. — There should be such complete-
ness and yet simplicity in organization that there
will be cooperation between the resident and con-
sultant staff, even though remote location may
prevent as frequent visits by the latter as can be
made in a general hospital ; nevertheless, the gen-
eral field of medical effort can be well covered.
Members of the visiting staff are, as a rule, con-
sultants, as the actual routine medical work must
be done by the resident staff, referring to the
medical staff eye, ear, nose and throat cases and
only special neurological, surgical and medical
cases. Smallness in numbers of the resident staff
or closeness to large urban centers would modify
this plan.
The resident staff of the colony will vary in
numbers with the size of the village, but in an
institution sufficiently large to permit of such an
organization, there should be first assistant
and one or more senior assistant medical superin-
tendents; several assistant physicians in charge
of groups or divisions, reception service, infirm-
ary service, etc., a woman physician, dentist.
The present military requirements, the reduced
number of medical graduates and the disinclina-
tion toward institutional work, are among the
factors causing increasing difiiculty in securing
for institutions physicians who are energetic
clinical research workers.
Team-work, including coordination with ad-
ministrative departments, is essential in main-
taining medical standards and the discipline as
the whole. Space will not permit going into de-
tail as to the scope of administrative duties each
and every assistant physician should accomplish,
but suffice it to say that each officer should in-
terest himself in all phases of the care and treat-
ment of the patients under his particular charge.
The number of resident physicians per patient
should be at least 1 to 250 for group for middle
and lower grades and 1 to from .50 to 75 for acute
hospital and reception services. There should be
among the resident staff a competent surgeon,
internists, a roentgenologist, a woman physician,
a dentist, a pathologist and bacteriologist and
psychiatrists, so that all phases of medical effort
can be efliciently advanced. The scheme of or-
ganization, for cooperation of scientific with do-
mestic departments, should consist of dividing the
colony in supervisory groups each under control
of an assistant physician and nurse, all reporting
regularly in writing and person to the medical
superintendent.
The arrangement of space for x-ray work, ex-
posures, skiagraphs, fluoroscopy, dark room, and
library should be adequate in the way of equip-
ment.
The character of the work in the diag-
nosis and treatment of disorders other than epi-
lepsy should be of as high a standard as in a gen-
eral hospital with a much more rapidly changing
population. To accomplish this, post-graduate
work in clinics located in our large medical cen-
ters should be mandatory for members of the
resident staff.
As the medical and nursing staff, so the char-
acter of hospital work will necessarily be. The
medical attention and activities are reflected
along the line from the physician with the high-
est authority to the probationer acquiring the
rudiments of nursing. Without an energetic and
enthusiastic corps of physicians, working hand in
hand, a proper hospital atmosphere cannot be
created and sustained. Petty jealousies and
fault-finding with lack of team-work do infinite
harm, whereas out-and-out free constructive criti-
cism is valuable. On the other hand, one who
cannot bear just criticism is a detrimental factor
and a drag in the institutional machinery.
Training School. — The training school for
nurses should have a competent principal who
can direct its work, and, aided by the assistant
THE MODERN HOSPITAL
369
physicians and head nurses, carry out successfully
a curriculum essentially practical in nature. Pro-
bationers of good reputation, active, in good
health and with a preliminary education of at
least one year high school should be sought. The
period of training should be three years, nine
months or one year of which should be in an
affiliated general hospital of high standing in a
near-by city, so as to give a broader experience.
The discipline of the training school should
be reasonable in nature, demanding both theoreti-
cal and practical efficiency. Classrooms with
proper apparatus should be had for lecture and
demonstration purposes. For those in training,
as well as for graduates, there should be proper
living accommodations in a separate cottage or
cottages, with single rooms for all, club rooms,
libraiy, etc., with opportunities for post-graduate
work of graduates of the school.
Laboratories. — The director of the laboratory
should be a trained pathologist and bacteriologist
with necessary assistants, both medical and lay.
The comprehensiveness of the scheme of organiza-
tion should permit the making of all routine
clinical tests: blood, cerebrospinal fluid, urine,
feces, sputum, throat cultures, Widal and blood
pressure, etc., as well as the furthering of re-
search work.
The scientific atmosphere of the colony under
inspiration of laboratories should be very ap-
parent. Neuropathological, general pathological,
biochemical studies with careful records of find-
ings and preservation of brains, various speci- .
mens, etc., should be actively pursued.
This work should be closely related to and in
many respects should be done with the coopera-
tion of the medical staff.
Phusical equipment should be ample: incu-
bators, refrigerators, miscroscopes, microtome,
centrifuge, photographic and microphotographic
outfits, animal house, etc. Architectural arrange-
ment should ensure spacious histological and
pathological work-rooms, with abundant light,
both natural and artificial. There should be well-
planned dark-room, gas, electricity, water, both
hot and cold, mortuary, autopsy room with cold
storage for bodies, library, space for storage of
specimens, etc.
Original Work and Publications.— The subject
of epilepsy and its phenomena, as well as related
or allied disorders, should be presented by the
pathologist as well as other members of the medi-
cal staff before medical societies and by publish-
ing papers on the same in general and special
medical periodicals. All original work should be
predicated upon thoroughness of investigation
with familiarity with all earlier work along simi-
lar or related lines.
Pharmacy. — The drug-room, with all facilities
for filling prescriptions, making of preparations,
pills, percolating, etc., so far as such might prove
necessary or desirable, with adequate storage
room, should be at a central point from which
prescriptions, etc., can readily be distributed to
various outlying cottages. It should be under
charge of a registered pharmacist with such as-
sistants as are necessary. In the outlying cot-
tages should be small drug cabinets for emergency
use and in which to keep filled prescriptions. The
pharmacy, while an important feature in a colony,
is perhaps relatively less so than in a general
hospital.
Out-Patient and Social Service. — Field work
should be arranged to follovv' up discharged pa-
tients, investigate applicants, diffuse information
generally about the aims of state institutions, and
for such other purposes as might suggest them-
selves. The director of social service should have
medical training, as should also, to some degree
at least, the assistants.
Many epileptics could readily live outside an
institution and arrested cases could be kept free
from symptoms, if the general principles of right
living could be planned and adapted for them by
experienced field agents.
The frequent holding of clinics at the institu-
tion to which physicians within reasonable dis-
tances should be invited and encouraged to attend,
should be developed. They are invaluable for
educational purposes and serve also to broaden
the resident staff in its outlook on the problems
of life.
The record-keeping system of this branch
should be comprehensive and a part of the general
medical records. These records should be type-
written with indelible ribbon, and free use made
of photographs. Harmony of this division with
other departments is very important for the
clinical work of the colony.
Correspondence with relatives has a larger
place in the matter of medical records of state in-
stitutions than is ordinarily the case in a general
hospital, the period of residence in the state in-
stitution of the average patient being much
longer than that of a general hospital patient. To
facilitate ready reference, all correspondence re-
garding a patient and a carbon copy of replies
thereto should be kept with the records of the
particular patient.
A comprehensive plan, not confusing or diffi-
cult of access, supervised by the medical superin-
tendent and kept in order by special clerks should
370
THE MODERN HOSPITAL
ensure completeness of records of medical work.
The case histories should be kept preferably by
vertical filing, permitting ready expansion, and
should include photographs, summaries, and the
use of cards to supplement the loose leaf. All
making of notes should be systematic, thorough,
scientific and, so far as possible, typewritten.
As Codman' says, case records are made for
the following purposes : (1) scientific study, (2)
for practical reasons, (3) for medicolegal reasons.
He suggests a fourth use of case records — as data
to fonn a basis for study to increase the efficiency
of the hospital. Records should be reliable, imme-
diate, adequate, permanent, and educational.
Fundamental in all work, but especially in a
hospital of whatever nature, is a conscientious
interest in its purposes. Without this, medical
work and the recording of the same will be a sad
failure.
While there must be cohesion and cooperation
between the departments controlling medical
records and accounting system, respectively, there
is really little or no direct connection necessary
in the state institution. The accounting system
should be simple, recording the data pertaining
to purchasing, receiving and distributing of sup-
plies. Farm, garden, industries, clothing, repair
and maintenance accounts must be kept according
to varying state laws.
In the dietetic department the scope of work
is general and special. In the large colony the
former is mostly indicated, as a simple diet of
broad application is what is sought. The dietitian
Vvith supervising nurses and physicians cooper-
ating can readily carry out such a plan. The diet
kitchen has a place for hospital and sick wards
only.
A general kitchen is not feasible in the colony
plan owing to wide separation of groups. The
cottage or group kitchen, the former especially
for better mental grades, is what must be made
use of. In serving rooms conservation of food can
go hand in hand with attention to appetizing serv-
ice. Small dining-rooms permit continued classi-
fication.
Each epileptic must necessarily have his in-
dividual symptoms carefully considered before the
proper treatment, especially as pertains to his
diet, can be outlined. With the care indicated ap-
plied, any list of articles of food given is one to
meet only general requirements and must be sub-
ject to modification for individuals. Diet for an
epileptic must be simple in nature, e.xcluding an
excess of meats, all pastry, alcoholic drinks, cakes,
sweets, small berries with hard seeds, cooked cab-
bage, and such articles of food as may apparently
not be easily digested by any particular epileptic.
All food should be properly masticated and close
supervision extended at all times to overcome any
tendency toward over eating. Menu gives mod-
erate variety under system of simple dietary.
Eqxdpment, Medical, Surgical and Physical. —
While the completeness of regular surgical ap-
paratus and furnishings in operating and dress-
ing rooms in the institution hospital should be
sufficient to meet ordinary demands of the simple
life, an essential feature of the colony for epilep-
tics calls for but a small part of such equipment
in a colony where the patients are of much longer
residence than in a general hospital. Special ap-
paratus for doing unusual technical operations or
venesection, spinal puncture, hydrotherapy, etc.,
should be available so far as may be required.
The furnishing of the cottages of the colony
should be complete. In some states the handicap
of being obliged to use prison-made furniture of
poor style and paucity of funds limits the carry-
ing out of well-laid plans for simple but adequate
furnishing.
Hospitals. The Mod-
Measures Against Influenza
A communication from Dr. Edward P. Davis, president
of the Volunteer Medical Service Corps, gives a number
of practical hints to be urged on the attention of fam-
ilies under the cai'e of members of the corps, which are
applicable everywhere in the present crisis. They include
the following:
Guard against the epidemic by thorough cleanliness of
houses, premises, clothing, utensils, and personal cleanli-
ness. Avoid stirring up dust. Wash, scrub, sprinkle, and
use soap and water thoroughly. Gargle the nose and
throat with an alkaline antiseptic frequently. Cooperate
at once to the fullest extent with the local, state, and
national health boards. Urge, and cooperate in, prepar-
ing towns and cities for the epidemic by establishing
emergency hospitals in suitable buildings, by districting
communities, and by apportioning medical forces com-
prising physicians and nurses, so that no portion of the
community is without medical care. Circulate and ex-
plain to the public the warnings and directions printed
by the United States Public Health Service and by local
health authorities. Urge the importance of fresh air and
the avoidance of chill and overheat. Give no medicine
and use no treatment which may depress the vital forces,
especially the heart.
Two injunctions which are especially emphasized are,
to avoid using supplies needed by the army and navy, and
to postpone all surgical operations which are not abso-
lutely necessary.
"The army and navy are fighting and conquering Ger-
mans. We must fight and conquer germs without taking
anything away from the army and navy. Don't ask the
army and navy for medical and surgical supplies. Use
simple utensils for sterilizing; the simplest kinds of beds
and bedding; make your own masks and dressings, and
fight for yourselves.
"While the epidemic is on, do no surgical operations
unless absolutely necessary to save life."
THE MODERN HOSPITAL
HOSPITAL ACCOUNTING
371
Accounts with Pay Patients-Superintendent's Ledder and Account with the Treasurer
—The General Cash Book
By CHARLES A. PORTER and HERBERT K. CARTER, of the Staff of The Modern Hospital
[Continued from October issue, p. 270]
PAY PATIENTS' CARD LEDGER ACCOUNTS
INDIVIDUAL Card Ledger accounts (Form 21)
should be kept with each patient, showing the
amounts paid in advance, board and attendance,
special nursing and miscellaneous items, the bal-
ance due or paid in advance at the end of the
month, and the overpayments made, which may
or may not be refunded. These cards are num-
bered numerically from 1, beginning the first of
by patients. As many of these accounts are never
refunded, they may be regarded as a part of the
earnings of the hospital, and a certain amount be
transferred from this account to miscellaneous
hospital earnings by the pi'oper Journal entry by
authority of the Superintendent.
At the end of each month, when all entries have
been made on the ledger cards, the totals of the
overpayments and advance payments can be
posted to their respective General Ledger ac«
counts as well as the accounts receivable from
patients at the end of the month. At the end of
the year it is customary to prepare a schedule of
these items, so that the directors may charge off
as much as they see fit from the two accounts —
Fie. 17. General cash book. Actual size, 9^4 by 14 inches. Bound
book, with binding margin to be added at the center.
each fiscal year, for reference and to indicate
directly the number of pay patients admitted to
the hospital each month. The total days' treat-
ment can also be figured from these cards if a
check is wanted on the census reports.
Payments by patients are entered on a Cash
Book and then posted to these individual accounts.
Overpayments by patients are payments made
THF Mode R hi hospital^
Town, Stp.t£, Date,
M No.
Room atna hifra Chanfes Payable h/eeklif in fldvance
rro^
To
r-reM
/
To Room Charcfei
" /Vt/r.5€A Fe&3
Bcejrd
' CuestA Chajrejes
■ Onertittna Room Chartt&s
" Te/£phone. Changes
- ^,frte/rle.s
ToTnL
/
Fig. 19. Pay patients' bill. Actual size. 8 by 6 inches.
The modern hospital No. lose
.5T L0Ur5. MO. 191 —
DOE NATIONAL BANK
vSt. LOUIS, MO.
Fig. 18. Combination cash and check book. Actual size, 12% by 3 inches, five to a page.
The headings appear only once at the top, the results being carried forward at the bottom
and brought forward at the top of tlie succeeding sheets. Bound book, with binding margin
to be added at left-hand sides.
by them for care not rendered and not to be ren-
dered. These must be carried as a liability by
the hospital, as they may be reclaimed at any
time by the patient, since the institution has
agreed to refund these "overpayments" when the
patient is discharged. These must be carried to
a General Ledger account entitled overpayments
overpayments and accounts re-
ceivable from patients.
OVERPAYMENTS BY PATIENTS
Refunds to patients are usu-
ally paid by check, but a much
more satisfactory method is to
make the refund in cash fi-om
the petty cash fund and obtain a
receipt from the discharged pa-
tient, or a relative, or adminis-
trator on a petty cash voucher. This saves
making out checks, and these receipts have only
to be totaled and posted to the Ledger.
PA- PATIENTS TRANSFERRED TO FREE LIST
When a pay patient is transferred to the free
list, a notation should be made on the Individual
372
THE MODERN HOSPITAL
Ledgez- card showing the date of the transfer.
This will prevent a bill from being chai-ged
against a free patient. Laxity in matters of this
kind will give the managers an idea that the
supei'intendent is not a good collector.
SUPERINTENDENT'S LEDGER
The books previously described are the Superin-
tendent's books of original entry, and are the
records from which the accounts in the Ledger are
posted. These accounts show the standing of that
part of the hospital's financial affairs that are in
charge of the Superintendent.
All entries from the Journal, Cash Book, Pay
Patients' Ledger, and the Charge Register are
posted separately or in total to these accounts.
The accounts usually found in this book are cash,
accounts receivable, superintendent's account
with the Treasurer, bills payable, overpayments
by patients, advance payments by patients, dis-
counts, materials, supplies, and unclaimed wages.
The footings of these accounts are used to make
up the Superintendent's Trial Balance and the
balance for his Balance Sheet.
The following examples will illustrate the man-
ner in which the entries are to be posted to the
various accounts. Explanations are given in de-
tail to show exactly how the items are handled.
The description of each entry is merely the
name of the other account under which this same
transaction appears. It is well to remember here
that "every debit must have an equal credit."
1. CASH
The General Cash Book (Form 17) will show the balance of cash at any and all times, so that
it is unnecessaiy to transfer this account to the Superintendent's Ledger, but the footings of this
account must appear in all trial balances and the balance on the Balance Sheet.
2. ACCOUNTS RECEIVABLE
Dr.
Total of previous months .? .
Superintendent's account with treasurer S,
For amount of bills accrued during the month
as per the statement of hospital earnings and
including earnings of ambulance, emergency
ward, unclaimed wages, dispensary, accrued
unclaimed overpayments, transferred to
hospital earnings, and material sold during
the month.
Advance payments by patients S .
This item is taken directly from the Pay
Patients' Ledger cards.
Overpayments by patients S .
This item is taken directly from the Pay
Patients' Ledger cards.
Total.
Cr.
Total of previous months.
Cash
This includes all cash received by the Sup-
erintendent during the month on account of
hospital earnings, and includes receipts for
ambulance service, of the emergency ward,
dispensary, material sold, and other miscel-
laneous receipts as per Cash Book.
Overpayments by patients
This account includes all overpayments
transferred as per Journal entry 2 to mis-
cellaneous hospital earnings.
Superintendent's account with treasurer
This account includes all uncollectible ac-
counts receivable charged off during the
month as per Journal entrj- 1.
Advance payments by patients ■
This item includes all accrued amounts due
and charged from this account .as per Pay
Patients' Ledger cards.
Total.
The difference in the totals of this account equals the accounts receivable at the end of the month.
ADVANCE PAYMENTS BY P.A.TIENTS
Dr.
Total of previous months $.
Accounts receivable $,
This item includes all amounts due, accruing
during the month and charged from this
account to hospital earnings as per Pay
Patients' Ledger cards.
Overpayments by patients § .
This item includes all advance payments of
previous months charged to overpayments
as per Pay Patients' Ledger cards.
Total.
Cr.
Total of previous months
Accounts receivable
For advance payments by patients as per
Pay Patients' Ledger cards.
Total.
The difference in the totals of this account equals the advance payments by patients as shown
on the Balance Sheet.
THE MODERN HOSPITAL
373
4 OVERPAYMENTS BY PATIENTS
Dr.
Total of previous months S .
Cash $ .
For overpayments by patients refunded
during the month as shown by the Cash
Book.
Accounts receivable $,
Accumulated overpayments transferred to
hospital earnings as per Journal entry 2.
Total S.
Cr.
Total of previous months
Accounts receivable
Overpayments by patients ns per Pay
Patients' Ledger cards, accrued during the
month.
Advance payments by patients
Advance payments of previous months
charged to overpayments as per Pay
Patients' Ledger cards.
Total
5 MATERIAL ACCOUNT
Dr.
Total of previous months
Purchases
As shown by the material account in the
Charge Register.
Superintendent's account with treasurer
Surplus amount of material as found by
inventory and debited to this account as
per Journal entry 3.
Total of previous months
Accounts receivable
Amounts due for sales of material during
the month as per Sales Book or Ledger
accounts.
Cash
For cash sales of material as per Cash Book.
Superintendent's account with treasurer
For loss or depreciation of material as
shown by an inventory.
Cr.
Total S Total $
The difference in the totals of this account equals the value of the material on hand at the end
of the month, as shown by the physical inventory, or by the perpetual inventory, if it is kept as it
should be. The supplies account is kept in this same manner.
6 SUPERINTENDENT'S
Dr.
Total of previous months $
Current expenses $
As shown by the Charge Register and
statement of same.
Capital expenditures (enumerate) S
As shown by the Charge Register and a
statement.
Cash $
For receipts of cash as per Cash Book
remitted to the treasurer.
Accounts receivable $
Accounts receivable charged off as un-
■ collectible during the month as per Journal
entry 1.
Material $
For loss or depreciation charged from this
account as per Journal entry 4.
Total S Total S.
The difference in the totals of this account shows the balance as on the Balance Sheet,
account must agree with the Treasurer's account with the Superintendent.
Or.
Total of previous months
Accounts receivable
For amounts of bills accrued during the
month, including all hospital earnings.
Cash
For all cash received from the treasurer
during the month.
Discount
The amount of discounts accrued for the
month and transferred to this account as
per Journal entry 7.
Material
For surplus amount of material found by
inventory and transferred to this account
by Journal entry 3.
This
7 UNCLAIMED WAGES
Dr.
Total of previous months
Cash
Unclaimed wages paid during the month. .
Superintendent's account with treasurer
Unclaimed wages transferred to hospital
earnings as per Journal entry 5.
Total
Cr.
Total of previous months $.
Unclaimed wages accrued during the month. . 8.
Total.
THE MODERN HOSPITAL
374
The difference in the totals of this account shows the amounts of unclaimed wages held at the
end of the month.
BILLS PAYABLE
Dr.
Total of previous months
Cash
Bills payable paid during the month as
shown by the Cash Book.
Discounts
As shown by the discount column in the
Cash Book.
Cr.
Total of previous months
Current expenses
As shown by the Charge Register and the
Superintendent's account with the treasurer.
Capital expenditures
Superintendent's account with the treas-
urer as shown by the Charge Register.
Total * Total «
The difference in the totals of this account equals the accounts payable as shown by the Balance
Sheet.
9
DISCOUNTS
Ce.
Dr.
Total of previous months
Superintendent's account with treasurer
Discounts transferred to Superintendent's
account with the treasurer as per Journal
entry 6.
Total S-
Total of previous months
Accounts payable
Discounts credited to bills payable as shown
by the discount column in the Cash Book.
Total.
This account should balance monthly. Discounts
are not hospital earnings and cannot be so con-
sidered. In a general business they would be
closed into the profit and loss account, but the
1 /> c c o u m-
No. I0<?6.
St Louis Mo 191
iH"3
^mIV.V
Ji;;:i^.:,
TOT-.
Rtctirca cf
,.„DOLl.«RJ
PatLtnts r/ame /vo
The MoDERn Hospital
. .. "1".....
Fig. 20. Pay patients' cash and receipt book. Actual size 3 by 11 inches, five to a page.
Duplicate sheet is bound into the book, on which headings appear only once at the top,
the results being carried forward at the bottom and brought forward at the top of the
succeeding sheet. Bound book, with binding margin to be added at left-hand side.
Superintendent's account with the Treasurer is
the closing account in this case, and it is just as
correct to charge such items as these cash dis-
counts directly into this account as to close them
into a profit and loss account and then transfer
them by means of a Journal entry to the Superin-
tendent's account with the Treasurer's account.
TRIAL BALANCE AND BALANCE SHEET
After all entries and postings for the month
have been made in the Superintendent's books,
the accounts footed and recapitulations made, a
Trial Balance should be taken off of Ledger ac-
counts (Form 24). This gives the names of
accounts and the totals of the debit and credit
sides. The totals of all the debits of the accounts
appearing on this sheet should equal the total of
the credits.
It is customary to arrange General Ledger ac-
counts so that assets appear first and liabilities
last in the Ledger and on the Balance Sheet.
A copy of the Superintendent's account with the
Treasurer and a copy of his Trial
Balance and Balance Sheet are
shown on the Superintendent's
monthly report (Form 24) .
Forms 22 and 22A show an
Expense Analysis. It is left for
each hospital to determine
whether it is wise for it to op-
erate under the budget sys-
tem. This system, described
later in detail, is growing in
P-TienT INo fNfflREJT RfLflT,(.e
n^ME 0„.L TO
f\ODI\tSS floOREJS
/»DM,TTEO R^re Ooc"fl«^EO
V.V.Z,,
'•J;-;-
f«:^T«
I7-,J
^•CUItT
n..^
fl-o-r-r
O.Tf
«-..«r
5^tfl«cf
Fig. 21. Pay patients' ledger card. Actual size, 7 by 6 inches.
favor among private institutions, and is almost
universal in municipal hospitals.
THE MODERN HOSPITAL
375
superintendent's monthly report to the
treasurer
The Superintendent should make a report to
the Treasurer as early in the month as possible,
giving a copy of his account with the Treasurer
and a copy of appropriations from special funds
to meet current expenses, his Trial Balance, and
Balance Sheet. (See Form 24.)
SUPERINTENDENT'S MONTHLY REPORT OF EXPENSES,
REVENUE, AND STATISTICS
In hospitals as well as in commercial institu-
tions the general custom has been to have a yearly
report and audit made. At this time inventories
were taken and the pi-ofit and loss account com-
pleted. During the last few years the fact that
it was not necessary to wait until the end of the
year to know the standing of the concern and the
condition of the business has been acknowledged.
It is now becoming the custom to make monthly
statements of expenses and revenues, assets and
liabilities, and surplus and deficit. These reports
enable the Board of Managers to keep a finger on
the pulse of the financial arm of the institution,
to plan to meet obligations, to plan future policies,
and to direct curtailments of expenses when nec-
essary, instead of waiting until the end of the
year, when the financial aflfairs of the hospital
may be hopelessly involved.
Form 2.5 shows a form of Treasurer's Monthly
Expense and Revenue Statement, and Form 26
shows the Treasurer's Monthly Surplus and Defi-
cit Account and Balance Sheet.
[To be continued.]
A SUCCESSFUL PRIVATE INSTITUTION FOR GIRLS
Modern Fireproof Building Provided at Moderate Cost — A
Home Free From Institutional Atmosphere
The women of Bloomingrton, Illinois, who have charge of
the Girls' Industrial Home have recently completed a very
wonderful building and financing project, described in the
Institution Quarterly as follows:
They have erected and furnished a new fireproof build-
ing, 100 by 40 feet, planned on the most modern lines,
furnished it throughout, and paid for it in cash from
funds voluntarily contributed by the people of Blooming-
ton and McLean County.
In these times of high prices of building material and
labor, it is difficult to understand how a building of such
size and excellence of construction could be had for so
small a sum of money, namely, $26,000. The building will
accommodate seventy-five girls.
The institution is organized under the Industrial School
Act and is twenty-nine years of age.
The purpose of the home is three-fold ;
First — To provide a home for dependent and homeless
girls of all ages under eighteen.
Second — To furnish a boarding place for girls having
some friends who will be responsible for their support
while in the home.
Third — To secure permanent homes in responsible fami-
lies, either by commitment or by legal adoption.
For years it occupied rented quarters, but from the
start its work has been so efficiently done that it has
appealed to the generosity of the local public and today it
owns three acres of valuable land in the city of Bloom-
ington and the new building, all of which is entirely free
from debt, and valued conservatively at $35,000. The
new building is fireproof. It is liberally equipped. All
the living rooms, working quarters, and dormitories are
light, well ventilated and plainly but well finished. It has
its own heating plant, and its own laundry.
The need of such an institution in this locality may be
se?n from the fact that since its inception it has annually
provided a home and care for from twenty to sixty girls,
and in that time hundreds of girls have been helped to
become good and useful women through the Christian
influence of its home life, while scores of families have
been brightened and blessed by the little bright-eyed baby
or girl they have taken from the home.
It is the aim of the management to make the home not
institutional in any way. There are no uniforms for the
children; there are no rules, other than those of the home;
there are no locks and bars.
The children go to the public school like other children,
suitably dressed; they go to church and Sunday school;
they go to picnics; they play and visit just as do the
children whom the world calls fortunate.
A kindergarten training is also provided, by volunteer
workers, for those under school age. Under the direction
of the heads of the various departments, the children are
all given such training in domestic science as will enable
them to become useful members of the families in which
they may be placed, as well as self-supporting when they
attain the age limit of the home. They are also required
to assist in the care of the grounds, garden, chickens, and
cows.
The doors are always open to the homeless child. Al-
ways and at any time, she may come in and be cared for,
educated, taught useful arts, and remain as long as it is
necessary for her to stay.
The corporate powers of the home are vested in a board
of sixteen members, four of whom are the officers, who
are elected annually by the board of managers.
Alder Hey, A Military Orthopedic Hospital
Most of the British orthopedic centers are palatial
establishments, either converted modern poor law hos-
pitals or asylums, or barrack hospitals built specially
for the purpose. They are situated in spaceous grounds,
providing ample room for the erection of auxiliary build-
ings. They have been established for the most part in
university towns.
Alder Hey Hospital at Liverpool was the first military
orthopedic hospital established. It is situated about five
miles from the center of the city, almost in the country,
on rising ground, with plenty of sunshine and fresh air.
It can accommodate 800 patients. In the hospital
grounds a number of curative workshops, a new gym-
nasium, electrotherapeutieal and hydrotherapeutical estab-
lishments and an operating theater have been erected.
An important feature is the massage department where
.500 i.itients are daily treated by 29 masseurs and
masseuses. The primary object of the curative work-
shops is improve the condition of muscles or to increase
the range of movement in a stiffened joint.
376
THE MODERN HOSPITAL
THE BAHAMA GENERAL HOSPITAL AND ASYLUM
A Progressive Hospital Group Which Includes an Infirmary, Asylum, and Leper Com-
pound—Staff Almost Entirely Native
By MRS. T. MILNE (Former Matron of The Bahama General Hospital), Superintendent of the John Sealy
Hospital, Galveston, Texas
THE Bahama General Hospital and Asylum is
a tjT)ical colonial hospital, containing about
two hundred beds. It includes a male and female
hospital (Alexander Hospital) and a male and fe-
male infirmary (Victoria Jubilee Infirmary).
The grounds about it are spacious and, lying on
Fig. 1. Male and female hospital.
the side of a hill, command a beautiful view of the
sea, which, with all its different colors, tends to
cheer the patients and help them get well. The
tropical flowers and Victoria palms make the
place look more like a home than a hospital.
The resident surgeon's home is within the
grounds, as is also that of the superintendent.
Situated on the top of the hill are the male and
female lunatic asylums, the isolation wards and
leper compound, the latter being entirely apart
from all other buildings. Directly in front of the
gates, at the end of the drive and the top of Pine
Avenue are the administrative
buildings, and matron's quar-
ters. The hospital itself is a
nice new building, but its sani-
tary conditions are by no means
modern. Although the commis-
sioners are anxious to make im-
provements, they have been un-
able to do so, for money is not
plentiful in the Bahamas now.
The superintendent, a man,
has full charge of the business
side of the institution. The
resident surgeon has been con-
nected with the institution sev-
eral years and consequently
knows the patients and condi-
tions well. The staff includes
two European graduate nurses,
a "matron" and a "sister." The
latter has charge of the hospital
quarters and adn
{•ig. l. Kesi.Jent nhysi
and nurses and also superintends the asylum, in-
firmary, isolation wards and leper compound.
Two graduate native nurses act as night super-
visor and charge nurse. At present there are
nine native female nurses in training, all of whom
are most anxious and willing to learn. They are
THE MODERN HOSPITAL
377
taught their theory by the matron and the prac-
tical work by the "nursing sister." The curricu-
lum includes theory and practical nursing, drugs
and solutions, ethics, surgery, anatomy, physiol-
ogy, obstetrics and diseases of children. The
hours of duty are from 6 :30 a. m. to 7 p. m. daily.
On Sundays these nurses are off duty alternately
from 9 :30 a. m. to 2 :30 p. m. and from 2 :30 p. m.
to 10 p. m. They are also off duty one half day
each week and three hours each day. The matron
and sister have comfortable quarters, and all
nurses and attendants are well taken care of. The
female nurses attend solely to the female patients,
while the male wards of the hospital are staffed
entirely by male attendants (one
head and three assistants, one of
whom is for night duty only).
Male nurses have the same hours
of duty and off-duty as female
nurses. A holiday of two weeks
is allowed to each nurse and at-
tendant yearly.
The Victoria Jubilee Infirmary
is for the aged and infirm, male
and female, who are not very ill,
those needing medical attention
being transferred to the hos-
pital. The infirmary is staffed
by a female native graduate
nurse with an assistant who is
one of the nurses in training.
The old women do the mending
when they are able. The male
infirmary, which is quite new
and a credit to the institution.
after the twenty patients who are now in the fe-
male division of the asylum. The male asylum is
quite new and has at the present time twenty-five
patients. It is staffed with one male head attend-
ant and five male assistants. All the patients who
are sufficiently quiet are allotted a certain amount
of work, hewing wood, carrying water, or attend-
ing to the hospital grounds.
The isolation wards are away from the hospital
buildings and are used for the dirty and infec-
tious cases. The male and female lepers' com-
pound wards stand alone and apart from all other
buildings. Five male patients are in the com-
pound at present. The doctors and matron visit
showing male lunatic asylum at left and female at right.
these wards at least twice a day, administering
treatments which consist chiefly of those Indian
oils said to be effectual in all cases of leprosy.
The mortuary is away and in a separate building ;
and even on a hot day it is quite cool.
The patients are mostly natives from Nassau
has one head attendant and an assistant.
The asylum receives both male and female pa-
tients. The sexes occupy different buildings, both
of which, standing at the top of the hill, overlook
the city and the sea. One female head attendant
and her four assistants are kept busy looking
Fig. 6. Leper compound.
378
THE MODERN HOSPITAL
and the surrounding
islands.
Three days a week
out-patients come to
see the doctors and, if
very poor, are given
both rations and medi-
cine. Before supplies
are given, however, the
relieving officer visits
all cases to inquire into
home conditions. The
patients wait for their
medicines in the dis-
pensary, and many are
the kinds of bottles
brought to put the
medicine into.
Fig. 7. Group of
natives in this colony
are such that they
should be happy in
their land of sunshine
and beauty. The nat-
ural surroundings are
ideal for producing a
spirit of cheerfulness,
conducive to recovery.
Nassau is a very beauti-
ful city, and very Span-
ish in appearance. The
exquisite blue sky and
sunsets are delightful
to behold ; and, with the
wondrous sea of many
colors, one can imagine
himself in fairyland,
The conditions and advantages surrounding the where war and trouble are unknown.
NEW FOUR-PATIENT COTTAGE AT BARLOW SANATORIUM
Simplicity of Design Combined With Comfort and Practicability — Low Cost of Mainten-
ance and Ample Supply of Sunlight and Fresh Air Assured
By WALTER C. KLOTZ, M.D., Resident Physician, Barlow Sanatorium, Los Angeles, Cal.
This cottage is designed to accommodate four
patients and has been adopted as the present
standard plan of construction in place of a for-
mer two-patient type. This larger unit has
been found more economical, and the ratio of one
bath and toilet to four patients has been found
adequate. At the same time, none of the advan-
tages possessed by the two-patient plan have been
sacrificed.
As shown by the floor plan, each patient has
an individual sleeping porch and comfortable
dressing room. The sleeping porches are all
placed at corners of the building, offering a south-
Fig. 1. New four-patient cottage at Barlow Sanatorium. Los Angeles.
em and also an eastern or western exposure.
This insures ample sunlight during a part of the
day and good cross-ventilation, besides affording
a considerable degree of privacy. An open porch
or terrace five feet wide extends all around the
presented by
building, except for a part of the south side.
This open porch can be used in the daytime and
offers a choice of either sun or shade, as may
be desired, according to the different seasons of
the year. Each dressing room is provided with
a built-in wardrobe and a chest of drawers. Be-
tween these is placed a white enamel stand for
washbasin and above this a shelf for toilet arti-
cles. Between the dressing rooms is located a
shower bath, with dressing room and bench, a
toilet, and, in an open recess, a slop-hopper, which
is used also as a dental lavatory. The shower
and toilet compartments, as well as each one of
the dressing rooms, have a good-sized window
placed in the wall on the north side, which sup-
plies ample light and air. In addition, screened
ventilator openipgs are left in the ceiling of the
dressing rooms and sleeping porches. These
lead into the attic space which is ventilated by
means of louvers placed in the gables.
The long interior corridor is lighted and venti-
lated by two windows on the south side near each
end. The sleeping porches are provided with
copper screens and also with canvas awnings on
each of the open sides, for use in stormy weather.
Hot water for the shower, bath, and hopper are
provided by a solar heater. The cottage is light-
ed by electricity.
The construction is substantial and permanent.
The foundations of the cottage and the open
porches are eight-inch concrete walls placed on
THE MODERN HOSPITAL
379
ample concrete footings. The space within and
between these walls is filled solid and tamped with
earth, over which is placed a two-inch cushion of
sand. Upon this is laid a three and one-half
inch layer of concrete, which forms the floors of
the cottage and porches. The building itself is
of good heavy construction. The outside sheath-
nocessary in our climate. In colder climates a
plant for heating the dressing and bath rooms
could be accommodated in a small excavated
basement entered from the outside. A coal or
gas heater for heating water could also be in-
stalled in localities where solar heaters would
not be adequate.
Fig. 2. Floor plan of the four-patient cottapes n<
were designed by Mr. B. B. Bixby, a Los Angele
his supervision.
ing of rough boards is covered with metal lath
and cement stucco plaster, which is also applied
as a finish coat to the foundation, walls. The
floor is of broken tile. The interior is ceiled
v/ith matched redwood finished in enamel paint.
A composition sanitary base is carried out for six
inches above the floors.
The cost of this cottage a year ago was $2,500,
including all furniture, equipment, plumbing and
wiring. The cost at the present time would be
at least $2,750.
No heating plant is provided, as this is not
The ground plan is, of course, adapted to dif-
ferent methods of construction, and the cost
would be inci'eased or diminished correspond-
ingly. The important feature, and the main ob-
ject sought, was to provide a four-patient unit for
ambulant cases, combining the greatest degree
of comfort and privacy with ample facilities for
fresh air and sunlight, a simplicity of design that
would keep down the first cost and involve the
least amount of service, and, at the same time, a
class of construction that would insure a low cost
of upkeep for repairs and maintenance.
A PRACTICAL REMEDY FOR HOSPITALIZATION
The Vancouver General Hospital Organizes a Plan to
Lessen the Number of Days' Stay of Patients in
the Hospital
By M.4LC0LM T. McEACHERN. M.D., CM., Superintendent Van-
couver General Hospital, Vancouver, B. C.
At a recent meeting of the medical board of the Van-
couver General Hospital I took up the question of patients
staying in the hospital too long, some of whom were be-
coming hospital. A committee appointed to confer with
me found the following conditions to exist:
1. Many patients, usually indigent people, paj-ing little
or nothing for their accommodation, were staying in the
hospital longer than they should, and thus constituting a
loss to the hospital.
2. This fact influences the medical attendant to keep
them in the hospital durin? the time of convalescence,
as they have no means to support themselves at home
and are not yet able to work. Another factor is that
mr-ny of them live in surroundings unfavorable to con-
valescence. Others still need dressings, treatment, special
diet, etc.
3. In reviewing cases of this type, our committee found
many in which the length of stay in the hospital was
apparently quite unjustified by the condition present;
many patients that could do equally well on outdoor treat-
ment; some whom their medical attendant saw only at
infrequent intervals, and so on.
4. Careful analysis of reports from the leading hospitals
in Canada and the United States show that the average
length of stay in hospitals is usually 14 to Ifi days,
whereas ours is 19 to 20 days. We are keeping our
patients in too long.
5. It may be pointed out that this state of aflfairs affects
adversely (1) the hospital, (2) the patient:
As regards the hospital: (a) This institution is pri-
marily designed for the treatment of active cases of ill-
ness. The hospital should handle only cases that are
actively progressing toward recovery or toward death.
Static cases, with permanent or long-standing disabilities,
are not suitable cases for hospital treatment. This hos-
pital has a thoroughly efficient convalescent home, an out-
door department, and a social service department. One
or the other of these departments can be called into
service as necessary, and cases can be placed with the
most ample consideration of their family and financial
circumstances, (b) Again, this hospital has a continual
deficit which, as pointed out, is only increased by this
t>T)e of patient. If at all possible, this should be stopped,
and the hospital has a perfect right to demand the co-
operation of the medical men in this.
From the patient's point of view two cases may be
quoted :
380
THE MODERN HOSPITAL
Case 1. Mr. J. C, in hospital for many weelcs, had no
money, some worry; complained of indefinite pain.
Seemed to have developed into a profound neurasthenic.
Doctor said nothing was wrong with him as far as he
could find out, and discharged him. The patient came to
my office furious at being discharged when he was so ill.
I could not get rid of him from here, so I asked his doctor
if I might take him out to the annex at Marpole. He
consented to let him go. I took him out, got him a room
with another patient who was quite well, had him come
back daily for high frequency, etc. The first night there
they had "a lively concert and the next night another, and
he was all i-ight in three or four days. Now he is work-
6. That the medical superintendent interview the doctor
and if necessary employ a letter ("Form B").
7. That after a case has been passed on by the medical
board, the medical superintendent shall have power to act
forthwith on their recommendation.
8. That medical men be requested at the earliest oppor-
tunity to give to the head nurse of the ward the diagnosis
of the case; this to be written on the front of the chart,
for use as shown above. If not given within twenty-four
hours, this should be obtained by the head nurse by direct
request.
FORM A
To be handed in to the Superintendent's office every Monday morning by the
THE VANCOUVER GENERAL HOSPITAL
Weekly Report of Patients in the Ward
charge. For all patients.
Number of
days in
hospital
Number of
visits made
by doctor
during week
ing hard. This man was in the first stage of hospitaliza- FORM B
tion. 1818.
Case 2. Mr. A. L. was brought to the Vancouver Gen- Dear Doctor:
eral Hospital in a reduced physical condition from lack You have a patient named John Smith in Ward "A." This patient
of nourishment and hygiene. After a few weeks he was has been in the hospital since January l, 1918, and is not receiving
transferred to the annex at Marpole for further con- active treatment, in the best interests of the patient, and as the
valeseence. He had been seen only occasionally here by hospital is urgently in need of beds, can this patient be —
his attendant. Routine dental examination at the annex — Discharged.
an advantage the patients there have over the patients in Referred to Outdoor Department.
the main hospital — revealed extensive teeth trouble. This Referred to Social Service Department.
was at once attended to and the man was discharged two Transferred to the Annex at Marpole.
or three weeks later and is now back to a productive life. Failing to hear from you. the above-named patient will come auto-
others might be cited to show that in the patient's '"='ti<=aUy before the Medical Board of Revision at their next meeting.
.. ,,, . ,„ ,«, Yours very truly,
interest there is need of a remedy for the present state of
affairs. General Superintendent.
As a remedy for the foregoing our committee suggested form c
the following" report of medical board of revision
Name
1. That a medical board of revision (of three mem- Admitted
bers) be appointed from the medical staff of the hospital, Address
or as they might see fit. Pay or Non-Pay
2. This board to consist, preferably, of one member Number of days in Hospital
from the consulting staff and two members from the active ivef "ment !.!!!!! ^ '!' !
staff, the medical superintendent to attend its meetings progress
and act in an advisory capacity. Examination reveals
3. (a) That this board meet twice a month, or at the Recommendations
call of the medical superintendent, pro re nata, to review
and examine any cases brought before them by him and _.' ' ' ' ,
bring in a recommendation as to their disposal, (b) Some ^
regular form, e. g., "Form C," to be filled out by the Chairman Medical Board of Revision.
board in each case.
4. That the medical superintendent have made to him *'^'"''^'" '^"^''=^' ^'""'^ °^ Revision.
a weekly report from each ward of all patients in the Member Med'icarBoard of "Revision."
ward ("Form A") . Dated this
5. (a) That he pick out such cases as seem to him to This entire system has been taken before the Van-
have been in the hospital longer than necessary or advis- couver Medical Association and their cooperation asked
able, and get in touch with the doctor in charge, (b) That for. It is now in force and has already given good results,
all cases in the hospital ninety days or over come before many of the doctors volunteering to have the medical
the medical board automatically. board of revision sit on their cases.
THE MODERN HOSPITAL
381
RELATION OF LABORATORIES TO HOSPITALS*
Improvement in Methods and Equipment of Piitholodiciil Laboratories — Laboratory
Workers Becoming Clinicians Functions and Values of Laboratories-
Specialization in the Laboratory
By WILLIAM CARPENTER MacCARTY, M.D., Mayo Clinic, Rochester, Minn.
ing, not the dead. The methods and value of the
By the term "laboratory," of which I am to
speak, I mean a room, building, or workshop
especially fitted with suitable apparatus for con-
ducting investigations in any department of
science or art.
This term includes the whole laboratory, or
series of laboratories. According to my own con-
ception of efficiency in the science of medicine,
the entire hospital is the laboratory and every
worker in the hospital is a laboratory worker.
Personally, I would not work in a laboratory for
the study of the ills of man which did not include
the whole hospital, to all parts of which I had ac-
cess. This does not mean that the one in charge
of laboratories should desire or expect to domi-
nate or in any way control all of the departments
of the hospital, but it does mean that only by
such breadth of vision can one fully appreciate
our problems, although each one of us may be
especially active only in one phase of the big
problem.
A few years ago, and perhaps even today in
some hospitals, the word "laboratory" conveyed
and conveys the idea of nothing more e.xtensive
than a small room, usually in the basement, for
the examination of urine, or perhaps a place where
some curious intern might stain bacteria.
In some hospitals, as we progressed, the term
became more extensive and was associated with
a small, usually the smallest, room somewhere in
the morgue. This was the pathological labora-
tory. It was a kind of customs house where the
last examination of earthly belongings was made
preparatory ro sending the body on its long jour-
ney back to earth.
From such humble surroundings there soon
evolved a building known as the pathological lab-
oratory. This still remained some distance from
the main hospital and always contained the
morgue. It was a kind of gate between the physi-
cians and the undertaker.
I have always believed that this association
with death takes the initiative of life out of many
a good scientist.
All of these conditions are changing; here and
there throughout the hospital one finds today
rooms equipped with various kinds of apparatus
— apparatus for the purpose of studying the liv-
•Read at the Third Convention of the Catholic Hospital Association,
laboratories have not only invaded the whole hos-
pital, but have invaded every branch of human
welfare. Laboratory workers are becoming clin-
icians who are specializing in the utilization of
certain apparatus for the purpose of preventing,
curing, and ameliorating the ills of their fellow
man. They are already an economic factor in the
progress of mankind. The time is too short for
me to enumerate statistically all of the laboratory
activities of man and their value as such a factor
in human progress.
In the practical hospital which administers to
the immediate demands of masses of people, the
functions and values of laboratories may be sum-
marized briefly. They are:
1. The determination of causes of death, the
actual cause being often clinically unknown.
2. Assistance in the making of pre-mortem
diagnosis by means of extensive examinations of
urine, sputum, blood, stools, excretions, secretions,
and tissues microscopically, bacteriologically,
physically, and chemically.
3. The actual making of pre-mortem diagnoses
such as result from examinations of neoplasms,
and the determination of types of diseases from
bacteriological examination and from metabolic
status.
4. The determination of the extent of thera-
peutic procedure by means of examination of urine
and blood, feces, sputum, and metabolic status
during course of treatment.
5. Prevention of disease, by vaccination
against smallpox, typhoid fever, tetanus, diph-
theria, cholera, etc.
6. The obtaining of prognostic data by deter-
mination of probable duration of life depending
upon microscopic evidence of malignancy or be-
nignancy of neoplasms and chai-acter of meta-
bolic condition.
One of the essentials of our definition of a lab-
oratory consisted of the term "apparatus." This
term is so broad that it includes everything from
the finest microscope or most accurate chemical
balance to the most insignificant article in a diet
kitchen. There is no place to draw a line between
what is apparatus and what is not. Therefore, I
say again that the entire hospital is the labora-
tory, or a series of laboratories.
In carrying out the six functions which have
382
THE MODERN HOSPITAL
just been mentioned, the instrument which we
call a microscope has played a most important
role, one so important that most laboratories and
workers are usually associated with it. This is
only one of many, but its importance may be seen
in the fact that during the month of July in our
clinic there were 7,706 absolutely necessary mic-
roscopic diagnoses made on the 4,752 patients
who were registered during that month. This
averages almost two examinations for every pa-
tient. Of this number of patients, there were 4.3
per cent which required a microscopic tissue ex-
amination in order to establish a positive diag-
nosis. Of 1,699 patients who came to operation
during that month, 61 percent produced surgical
specimens, 20 percent of which required a neces-
sary microscopic tissue diagnosis.
It might be stated here that the clinician has
a percentage of diagnostic accuracy when he
makes a positive diagnosis of 95 percent. As a
matter of fact, however, 22.6 percent of the can-
cers of the breast which pass through his hands
are discovered positively in the surgical labora-
tory. When our clinicians make a diagnosis of
carcinoma, or inflammation, in the breast, they
are correct in only 49 percent.
These figures, startling as they are, compare
favorably with the results in other organs of the
body, and serve to prove the necessity for immed-
iate tissue diagnosis in connection with surgical
procedure unless the surgeon wants to submit his
patient to two operations (thus doubling the surg-
ical risk), or to take a chance on his ability to
diagnose tissue grossly. If he does the latter, he
is assuming a proficiency in tissue diagnosis which
statistically he has no right to assume, and is sub-
mitting his patient to the ravages of his own con-
ceit or ignorance. In the laboratory of surgical
pathology in our clinic, men who have spent their
lives doing nothing else but examining and study-
ing tissues grossly and microscopically in their
relation to the patient under the most favorable
circumstances, must of necessity examine over 20
percent under the microscope before a positive
diagnosis can be made.
These figures represent the efficiency which
has followed a careful whole-time study of over
a hundred thousand surgical specimens during a
period of training with the microscope of twenty-
four years. Perhaps interns today, whose opin-
ions are relied upon in many hospitals for tissue
diagnosis, belong to a race of supermen. If they
do, they soon fall from that mighty position when
in the environment of ordinary men who have
had large experience. The mistakes of these well-
meaning and conscientious young men should not
be counted against them. The fault rests upon
the youthfulness of the system of medical science
which you and I have had as a part of our in-
heritance. We were born too soon. We were
born at the period of transition of medicine from
an art to a science, and such transitional periods
in nature are usually filled with mistakes.
Great laboratory leaders in this period have
been busy discovering and establishing new prin-
ciples. They have been too busy to associate with
the details of clinical medicine. Great physicians,
on the other hand, have been too busy ministering
to the immediate sufferings of humanity to spend
time in laboratories. Such isolation at this stage
of our development, associated with the duties
of teaching students, has been largely respons-
ible for the slowness of cooperation of labora-
tory methods and facts with clinical methods and
facts.
There is one other factor which I hesitate to
mention, but the good of humanity demands that
some of the more fortunate of us not only men-
tion it, but clearly state the facts for the benefit
not of ourselves, but of others.
The question of compensation for laboratory
workers is a vital one, so much so that there is
a great and almost disastrous dearth of well-
trained laboratory experts. They are not being
made for the simple reason that young men must
live and allow their families to live social lives
commensurate with their intellectual training.
Money, I am thankful to say, has never been the
desire of the medical profession, but if the prac-
titioners of medicine continue to look upon labora-
tory functions as being in no way equal to their
functions in rendering service, the medical pro-
fession will either become purely commercial or
it will be threatened by the same conquest which
now threatens the social world as a whole in the
establishment of social justice to all.
It behooves leaders of both purely clinical and
laboratory methods of rendering service to coop-
erate not only in their services, but also in their
compensation, whatever that compensation may
be. This can be done throughout the medical pro-
fession. It is being done by some leaders in a
just, honorable, equitable, ethical, and gentleman-
ly manner to the satisfaction of all parties, espe-
cially the patient who reaps the reward of the
highest type of efficiency.
What I have said briefly and generally so far is
in the nature of destructive and constructive
analysis.
From a purely constructive point of view, time
permits only certain suggestions which are de-
rived from isolated experiments which have been
carried out successfully in a few hospitals with
which I am personally acquainted. The experi-
THE MODERN HOSPITAL
383
mental stage is passed and it only remains for us
to summarize the generalizations.
1. Some leaders in the medical profession have
selected young men who have manifested natural
inclination and capacity for laboratory methods
of investigation from research and clinical points
of view and encouraged them by opportunities and
just earthly compensation. As a result these
young men are enthusiastically striving to ad-
vance and are actually advancing the science of
medicine along all lines for the sake of humanity.
2. Some trustees of hospitals with whom I am
acquainted have been successful and efficient busi-
ness men from the point of view of methods and
some of these men are realizing that human pro-
gress is dependent absolutely upon the health
and happiness of mankind. Such men are, by con-
structive and efficient methods, organizing hos-
pitals for the science of medicine, fully equipped
structurally and functionally for efficient service
in all branches which are productive of efficiency.
3. Some laboratory experts are beginning to
prove statistically the inefficiency of some of our
old methods and the efficiency of newer methods
of intimate cooperation of departmental science
in the practice of medicine in hospitals.
4. The general public is beginning to demand
laboratory examinations, a fact which is evidence
that the layman has begun to learn that the prac-
titioner of medicine must be something more than
the possessor of a pleasant personality and a ca-
pacity to arouse blind faith.
In conclusion I wish merely to state that as
one trained in laboratory methods and intimately
in association with clinical medicine, I am con-
vinced that no hospital has reached the highest
efficiency which has not coordinated the best lab-
oratory methods with its rendition of service to
its patients, and that no practitioner can render
the most efficient service who does not call labora-
tory methods into consultation.
Unfortunately, we have not enough well-trained
laboratory men, but they can be made only by
your recognition of their value and your material
and moral assistance.
I regret that time does not permit me to pre-
sent to you the vast statistics which I have at my
disposal to prove accurately the relationship which
does exist in some hospitals and must soon exist
in all hospitals.
My mission at this time is one only of stimula-
tion. You who are eager to render the best serv-
ice will look for the statistics. Your presence
here has already proved your desire for improve-
ment. You are ready for the big conception that
this is not only a day of specialization, but a day
of the coordination of specialization for the cure,
amelioration, and prevention of disease; and the
coordination to attain these ends can be carried
out only in hospitals which I still conclude are
nothing but laboratories.
Now, let me answer from experience the ques-
tions "Who should direct them?" and "Who
should do the technical work?"
True science knows only the greatest efficiency
as a goal; and the greatest efficiency in labora-
tory direction is not confined to any sex, race, or
religion. It deals largely with the personal equa-
tion of accui-acy of observation, correlation and
generalization.
It is logical to suppose that an individual who
has been especially trained and has had a large
experience might render greater service than the
untrained and inexperienced. It is also logical
to suppose that any individual who devotes his
whole time to a subject will in the same number
of days be more efficient. It takes time to train,
and time and experience travel in parallel lines.
It seems logical to suppose that an individual who
has experience and is trained would make a more
efficient director than the experienced or partially
experienced, untrained, or partially trained indi-
vidual. Since laboratory methods are becoming
more numerous and are changing, and the facts
are rapidly increasing, there is no individual who
is trained completely. It is purely a relative
matter.
My advice is simply this: Obtain for your hos-
pital the best-trained and the most experienced
young man or woman who has great possibilities
of growth. Never take a finished product. I have
a suspicion, inferring from the subject presented
to me, that you really want to know if your
laboratory director or worker should be a practi-
tioner, and my answer is that he should serve
only as a consultant.
The question as to who should do the technical
work is a matter to be dealt with just as was that
of the director. Any individual who is physically
and mentally fit can do any technical work in any
laboratory. In our own laboratories we have girls
and boys as technicians. There is absolutely no
reason why sisters cannot do the technical work
of a laboratory just as well as they do the numer-
ous other important technical things which make
a hospital a success.
In conclusion allow me to express publicly our
great appreciation of our own good sisters, led by
Sister Mary Joseph, who have at all times heart-
ily cooperated in every possible way in our ef-
forts to serve humanity best.
By examining the tongue of a patient, physicians find
out the diseases of the body, and philosophers, the dis-
eases of the mind. — Justin.
384
THE MODERN HOSPITAL
FROM OLR FIELD EDITORS' NOTEBOOKS
A Marvel of Modern Architectural Landscape Gardening Around a Washington Children's
Hospital— A INew York Hospital Which Has Sent One-Half Its Staff to the
Front— Attractive Features of Some Indianapolis Hospitals-
Some Interesting Philadelphia Hospitals
The Children's Hospital, Washington, D. C.
The front of the hospital is a long old brick building;
that is, it seems to be brick, as far as one can judge from
the glimpses one catches of it hei-e and there through the
ivy that covers it almost completely. Over the front
porch a sign reads, "The Children's Hospital, Incorporated
1870."
The ceilings of the old buildings are very high. An old
walnut bannister leads to the first floor. On the right of
the hall is a full wall length memorial tablet in brown
and white marble which looks strangely like the entrance
to a tomb. On the same side of the hall is the reception
room, a parlor of true colonial solemnity, brightened by a
bowl of roses of a vivid living pink. The hospital blooms
everj'where with fresh cut flowers, which are sent several
times a week by the Agricultural Department of the Gov-
ernment.
The older buildings are used almost entirely for col-
ored patients. There were dark-skinned babies and chil-
dren, black and yellow and almost white. The screens on
the windows of the wards were for the protection of up
patients, and the creeping ivy on the outside of the build-
ing had climbed on the meshes of the wire until it almost
covered the windows.
The newer buildings of the hospital are constructed
about a court, and are connected by passageways. These
connecting corridors are covered by stone walked balcon-
ies, surrounded by stone railings. The new buildings
blend in a perfect harmony with the older ones.
The court is known as the Memory Garden, and is a
marvel of modern architectural landscape gardening. In
the center a fountain plays lazily in its stone basin. Stone
seats of pure design are scattered around the circular
bricked courtyard. The chimney of the heating plant fac-
ing on the court is covered with ivy almost to the top,
and the same ivy winds around the side walls. Thick
shrubs and plants make shade and seclusion and an ideal
resting-place. On the outside of the buildings are roomy
lavms, and shade trees give a pleasant note to the chil-
dren's playgrounds.
In that part of the newer buildings known as the white
medical and surgical wards, the mattresses and springs
are removed from the cribs in the warmer part of the year
and replaced by stretched canvas hammocks. They have
proved to be more cleanly and comfortable during the
summer months.
The day I visited the hospital, the weather was damp
and cloudy and a cozy grate fire burned in the nursery to
warm the chilled air for the babies.
One of the new pavilions has endowed suites for moth-
ers and children. Each suite consists of a mother's room,
a bathroom and a room for the child. At the end of each
of the corridors there is a mother's dining room and a
sun-parlor.
The Children's Hospital affiliates with the Garfield Hos-
pital and the Eye, Ear, Nose and Throat Hospital of
Washington to complete the education of its nurses in
training, and with the Homeopathic and George Washing-
ton Hospitals to furnish special training in the diseases
of children for the nurses in these hospitals.
The lower floors of the new building are used for dis-
pensary and out-patient department, and baby welfare
station. About forty patients a day are treated here. A
social service nurse is employed. Medical officers of the
government hospitals are assisting in the radiographic
work of the out-patient service.
Miss Charlotte Estes is acting superintendent of the
hospital at present, relieving Miss Woodworth, the former
superintendent, who is now chief nurse of a convalescent
hospital in France.
Roosevelt Hospital, New York City
Roosevelt Hospital was founded under the will of James
H. Roosevelt, and incoi'porated in February, 1864. It
occupies the block of ground between Fifty-eighth and
Fifty-ninth streets, between Ninth and Tenth avenues in
New York.
During the year of 1917, 30,225 persons were treated
in all departments of the hospital.
A base hospital unit with a personnel representing
about one-half of the staff of physicians and nurses of
the Roosevelt are in service in France. Mr. Clarence H.
MacKay furnished standai'd equipment for this unit. A
late report tells that the unit is caring for nearly four
thousand patients.
Staff surgeons remaining on duty at the Roosevelt Hos-
pital are giving instructions in surgical technic and frac-
ture work to army surgeons, and the head nurses, under
the supervision of the directress of the training school,
are giving an intensive training to Red Cross classes of
nurses' aids who are being prepared to supplement later
the regular nurses in the army hospitals here and abroad.
Many of the buildings of the Roosevelt Hospital are
old, but have been kept in splendid condition. A more
modern surgical pavilion is planned and is only awaiting
normal, after-the-war conditions to spring up in place of
the old one.
The operating service of the hospital is closed to all but
the regular staff, but a small courtesy operating room is
maintained in the private pavilion for accredited visiting
surgeons whose patients are in the private rooms of this
department. There are solariums for both men and
women in the private wing, each equipped with its own
dressing rooms.
The radiographic department of the hospital has the
last word in motor mechanics, switchboard, lead protec-
tion and the most accurate mechanics for time exposure
and for stereoscopic work. The assistant on duty in this
department is an enthusiast.
The nurse's home in usual times has a capacity of 160
beds, and each nurse has a room to herself, but the larger
war classes being taken in have made it necessary to
crowd in many more than this number at present. Con-
trary to the usual custom of architects who plan nurses'
homes, the architect of this building has provided wide,
roomy closet space in the nurses' bedrooms; they have
double doors and covered cupboards above them. Just off
the large living room is a generous parlor. It overlooks
some quaint old vine covered walls and a busy street cor-
ner.
THE MODERN HOSPITAL
385
The nurses' aids in training at Roosevelt Hospital have
a special instructor. They are given 240 hours of class
and demonstration. All of the young women taking this
training have already had the usual courses given by the
Red Cross, and the intensive ti-aining received here in
addition will make them valuable assistants to the nurs-
ing forces now in service.
The Roosevelt Hospital is upholding in every way the
dignity of its traditions and its reputation of loyalty to
the government.
Indianapolis City Hospital, Indianapolis
The walls of the Indianapolis City Hospital building,
known as the Burdsell Memorial, are covered with re-
markable frescoes. The visitor walks through halls
adorned with painted figures, the size of life, of dryads
and satyrs and dancing maidens, and heroes of the Greek
myths, vivid impressions of green ti-ees and still waters
and blue skies.
In one children's ward the side walls show cats and
dogs and barnyard fowls. In another there are portraits
of children of different nationalities — a Scotch lassie and
a little girl from Italy, a Slav boy and another from
Japan, and so on do\\Ti the walls above the long rows of
white Tib beds. The babies' ward has pictures of the
children's old friends, the people in the fairy tales and
nursery rhjTiies.
In one male ward great wall spaces are covered by pic-
tures of the seasons, painted in the brilliant colors of
spring, the soft greens and blues and maize colors of
summer, the blazing red and yellow and brown of autumn,
and the w-hite and gray of winter.
One large ward on the top of the building, with large
windows all around it open to the light, is known as the
women's prison ward. The patients are all women from
the jails and the streets. The walls here carry great
painted spaces, reaching almost from the floor to the ceil-
ing, of Christ in the manger, Christ in the carpenter shop,
Christ in the streets of Jerusalem.
Several artists, foremost among them one of the col-
ored race, from Indiana and other states gave their time
and labor to the walls of the Indianapolis City Hospital,
in the hope that they might help to bring a note of
cheer and beauty into the lives of the city's poor who are
cared for there.
The Methodist Hospital, Indianapolis
In the Methodist Hospital, Indianapolis, there are well
ordered rows of convent beds. Walls of corridors and
wards and service rooms have attractive colorings, and very
evident effort has been made on the part of the manage-
ment to avoid a cheerless hospital atmosphere. In the
operating suite are very distinct units of service. Each
operating room has its own anesthetic room, scrub-up
room and supply cupboards. These cupboards open through
the wall into both rooms that they serve, saving the
running through doors and around corners to get needed
supplies. The sterilizing rooms and all sterilizing
apparatus and water heaters are on a balcony, with win-
dows as well as outlets for escaping steam. This keeps
the entire surgical suite free from condensing steam and
the noise of open valves.
Of the twenty student nurses graduated in the last class
from the hospital, seventeen have enrolled for active serv-
ice in the Red Cross. The only reason that the other
three did not volunteer was either that they could not
pass the physical examination or that they were going to
get married.
The hospital now has 250 beds and 165 nurses. They
are taking in an extra war class of 30 in July and expect
to have 200 nurses by the fall. This is surely doing their
best to meet the national need for nur.ses. The Methodist
Hospital is certainly teaching and preaching patriotic duty
and getting results to which it may point with pride in
post-bellum days.
There are three salaried anesthetists employed ; one of
these is a woman. Senior student nurses are getting four
months instruction in laboratory and radiographic work,
and by taking some further post-graduate study may
qualify to meet the present demand for laboratory and
radiographic technicians.
The Children's Hospital, Philadelphia
To reach the Children's Hospital one has to go through
the crowded colored quarters of the city, through narrow
streets and past other streets that are so close together
that it takes three of them to make a good city block.
Rosewood street isn't quite six feet wide, but it is in the
directory and just swarmed with houses and children.
The Children's Hospital is still in its first quarters,
which, when the war is over and its new building plans
are completed, will be used for dispensary purposes only.
A lovely blue painted and white-bound Bambino graced
the front hallway. A white-capped and gowned nurse was
carrying a very black pickanniny, and just in front of the
information desk sat a tired and worried woman, a
foreigner, with a sick white-faced baby in her arms, telling
her story to the information clerk. In front of the switch-
board a neat colored girl was answei-ing the incoming
calls.
The hospital is seriously handicapped at present because
of its staff being reduced to a minimum on account of
war needs. Very little surgery can be done at present.
The few men remaining on the staff are working like
heroes, but much of the work necessarily has to remain
undone.
There are seventy-five beds in the hospital, and a lai-ge
dispensary service is kept up by the institution.
The information clerk told me a funny story about a
colored woman who works for them. Someone said to her,
"Say, Mandy, is your husband in the next draft?" and she
answered: "I don't know fo' shoah, Miss, but he's been
a-limpin' lately most awful. I never done see so many
men folks linipin' in ma life befo'. Since this new draft
law come in everybody's a-bujin' canes."
Mercy Hospital, Philadelphia
The Mercy Hospital, which is an institution maintained
for the care of colored patients in the negro quarters of
Philadelphia, has been made from a row of quaint old
brick houses with marble steps leading into them. Out-
side of the little office is a brick courtyard, with an old-
time latched wooden gate in its wall.
The board of directors are planning to build a larger
and better institution to carry on their work, and a cam-
paign and benefit to raise funds is being undertaken at
the present time.
The training school has been established since 1907, and
since that has graduated fourteen nurses, who have gone
out to do good work among their people in hospitals and
homes for the aged and infirm.
An active woman's auxiliary is doing good work in
securing donations of furnishings and food supplies for
the hospital.
East Haven Hospital, Richmond, Ind.
At the East Haven Hospital (mental), Richmond, In-
diana, it is a custom for either the superintendent or his
assistant to see personally every day every patient in the
institution and to shake hands with him. The resident
staff believes that this personal contact is of immeasur-
able value in the care and treatment of the insane.
386
THE MODERN HOSPITAL
MODERN HOSPrTAL
EDITORIAL AND PUBLICATION OFFICE.
58 East Washington Street. Chicago.
He
Fr
W
s.
nry M. Hurd .
deric A. Washbu
nford H. Smith
S. Goldwater
L. Babcock
n A. Hornsby .
MA
K. Chapin . .
EDITORS.
. Fidelity Building. Baltimore
rn . Mass. General Hospital. Boston
Johns Hopkins Hospital, Baltimore
. . Mt. Sinai Hospital. New York
Jol
M.
58 East Washington Street,
NAGING EDITOR.
58 East Washington Street.
Chicago
Chicago
SUBSCRIPTION.
Domestic postage, $3.00. Foreign postage. $3.50 (15
Shillings). Single copies, 35 cents.
Domestic rates include United States, Cuba, Mexico.
Porto Rico, Canal Zone. Hawaii, and Philippines.
Contributors, subscribers, and readers will find im-
portant information on advertising page 42.
mm
The Influenza Situation and the Hospitals
The current epidemic of so-called Spanish influ-
enza has thrown a staggering burden on our hos-
pitals. The situation would have been serious in
normal times, but today the depletion of medical
and nursing staffs by the demands of the army
adds an element of strain which cannot be ignored.
Situations of difficulty and stress, calling for clear
heads and stout hearts, however, are .I'ust what
hospitals, physicians, and nurses are trained to
cope with ; panic in their ranks need not be feared.
Fortunately, there are signs that the high point
of the epidemic has passed. Further suffering,
sickness, and death there is bound to be, but de-
termined action is backing up good counsel, and
the thing most needed now is for every one to
understand exactly what his part is in the battle
against the common enemy.
What can the hospitals do? So far as devoted
effort and sacrifice are concerned, most of them
are doing all that is humanly possible, but sug-
gestions as to improvement of method are doubly
welcome now. Surgeon-General Rupert Blue of
the U. S. Public Health Service has issued a per-
sonal and urgent appeal that nurses be released
from private duty for influenza epidemic work,
that all except urgent operations be postponed,
and that volunteer nurses' aids be employed.
It is obvious, of course, that every nurse and
every woman who is capable of nursing has a duty
to perform in the present crisis; and the duty
of everyone who can release a private nurse for
epidemic service is no less obvious. Hospitals at
present should firmly discourage that perfectly
natural phase of human selfishness which consists
in the desire to pamper one's own invalid to the
neglect of others who may be suffering real
danger.
Operations should be discouraged for two rea-
sons ; in the first place, the patient incurs an addi-
tional risk in undergoing anesthesia now when his
system may be already undermined by infection;
secondly, every operation increases the need for
special nursing, since a private nurse is needed for
at least forty-eight hours in each operation case.
That it is the duty of every hospital to employ
and to train nurses' aids is the firm belief of J. 0.
Cobb, senior surgeon, U. S. Public Health Service,
in charge of the division of Illinois and Indiana.
One trained nurse on an eight-hour shift should,
with ten aids under her, be able to care for sixty
patients on a floor. Dr. Cobb has called on the
public press to ask women to help in this emer-
gency as a patriotic duty.
The nurses are thoroughly protected from all
possible danger by gauze masks when on duty, and
prophylactic doses of Rosenow vaccine. It may be
added that arrangements are under way to pro-
duce a hundred thousand doses of the Rosenow
vaccine daily.
It may be reassuring to know something about
the way the U. S. Public Health Service is meeting
the emergency, and Chicago, part of the division
under Dr. Cobb's supervision, may be taken as an
example.
The city has been mapped out in districts,
and every nurse and doctor in each district
is instructed to report any case of influenza under
his or her care to district headquarters. Through
cooperation of the Public Health Service, the local
Red Cross, and the Visiting Nurse Association of
Chicago, arrangements have been made to supply
medical and nursing care wherever needed. A
cheering feature of the situation, by the way, is
the fidelity with which nurses on this service have
adhered to their duty though tempted by offers
of double salary if they would desert their posts
to take private cases.
The epidemic is by no means over, but, by the
means just mentioned, with the aid of the hos-
pitals and physicians, and with public meeting
places closed by local authorities, the end is be-
lieved to be in sight, and aid of some kind assured
for all who need it.
THE MODERN HOSPITAL
387
The Training and the Rewards of the Woman
Hospital Superintendent — Both Sides
of the Question
Much is being said and written about the quali-
fications and special training of hospital superin-
tendents. Except in large institutions, where
medical men or business men of exceptional ability
are in charge, receiving salaries of five to ten
thousand a year for their work, most of these
superintendents are women, graduate nurses.
Many successful women superintendents had no
opportunity, at the time they began their super-
vising careers, for any special preparation, and
have trained themselves and created their own
success. The time of the self-made executive has
gone by, however, and today, quite rightly, the
woman who wishes to become a hospital superin-
tendent must fit herself for the position after she
has graduated from a training school. If the hos-
pital where she was trained is a small one, she
must go to a larger institution for postgraduate
work, where there is more clinical material to
observe. She must have experience in minor
supervising positions. She should have special
postgraduate training in nursing education and
hospital economics. She must be a member of
national nurses' and hospital associations and at-
tend their meetings, and she must keep herself
informed on all literature concerning hospital
betterment.
So much for what she must be and do to fit
herself for the superintendency of a hospital.
Now, on the other side, what is she going to get
for all this preparation and what consideration
will be shown to her in the position she will
occupy?
There are many small hospitals which pay no
more than seventy-five dollars per month and
maintenance to a superintendent ; many fifty-bed
hospitals pay only a thousand a year and some are
giving a salary- of twelve hundred. The superin-
tendents of these institutions sometimes have
enough graduate assistants to help with the super-
vision. More often they do not. Frequently these
women have to do the work of two or three, and,
in the small towns where everj^body knows the
business of everybody else, they are severely
criticized if any detail of the supervision is neg-
lected. Very often such a superintendent has at
best three assistants w'here she needs four, most
frequently only two where she needs four, and
in many cases only one. In several fifty-bed hos-
pitals the superintendent has no graduate assist-
ants at all. One successful hospital of sixty-bed
capacity in the Middle West, owned and controlled
by a group of doctors, specialists and capable men,
is doing the best work in that city. The superin-
tendent is a capable woman, specially trained for
hospital supervision, having had her graduate
work in hospital economics and management in
one of the large institutions superintended by an
authority in hospital administration. The hos-
pital mentioned was decidedly untidy, the nursing
care of the patients without proper supervision,
and the superintendent exhausted. She had a
dietitian but no assistant or operating supervisor.
The building was full of patients, and it was not
humanly possible for any one woman to do the
work in her own office, assist at operations, and
be on the floors to supervise the nursing care ; yet
I have no doubt that she was being subjected to
criticism for work left undone.
In another busy fifty-bed hospital, this extreme
example was found : The superintendent was on
the ragged edge of nerves. Her face was gray
with fatigue. She had an operating supervisor,
but this was the sum total of her force. There
was no assistant, no dietitian, and not even a book-
keeper in the office. The superintendent did her
own bookkeeping, tended the office phone, taught
the nurses, planned the diets, and housekeeping,
and did everything else. She was getting a
thousand a year and was a promising candidate
for admittance to a psychopathic ward.
In one thirty-bed hospital — and this is only one
instance out of many such — the superintendent
did everything there was to do, with one assistant
who did not have enough fundamental education
to teach a practical class or make out a week's
bill for a patient. This superintendent was book-
keeper, office girl, dietitian, teacher, housekeeper,
and buyer, did all the radiography for that
county, cooked supper Wednesday evening when
the cook was off, and sometimes fired the furnace
on Sunday afternoon when the janitor was out.
She was frequently criticized by the staff" because
she could not do the laboratoiy work and because
she did not always attend every operation.
Do the people in the large hospitals ever realize
what these women in the hospitals of the smaller
cities and towns must endure, where there is no
restraint in management or system to protect
them as there is in the larger institutions ? These
women, no matter what ability or tact or person-
ality they may possess, are open to discussion by
the people of the town and must suffer many
humiliations in silence. All the petty jealousies
and personalities of the trustees and the staflF, the
nurses and patients become stumbling-blocks in
the way of their work. In many places the super-
intendent must put up with an incompetent helper
because the individual in question happens to be
388
THE MODERN HOSPITAL
a relative or a protege of some board member or
physician and acts as a go-between to report to
the patron the superintendent's daily goings and
comings. In some places she must buy the meat
this month from John Smith, a local magnate who
gave one hundred dollars to the building fund, her
drugs from James Brown, a grafting retailer who
happens to be the brother-in-law of the treasurer
of the board, and send the dead to Joseph Jones,
the undertaker, whose wife is the president of the
Ladies' Aid.
She probably has to buy the stock food supplies
locally and pay from five to fifteen percent more
for them than she would have to if she were free
to buy where she could do best for the hospital.
She sometimes has to submit everything she plans
to do to a committee of women who know nothing
of hospital management and who treat her at
times with less consideration than a foreman
would treat a factory hand. And this woman in
the small-town hospital must not resent anything,
because the town is a little world in itself and Dr.
Brown and Mrs. Jones, who wouldn't count for
anything either socially or financially in a big
place, are powers in the little one.
There are two sides to every question. While
we are insisting on the proper training and prepa-
ration of these small-hospital superintendents, let
us insist too that they shall be paid better, given
enough assistance, and treated with the considera-
tion due to professional women in positions of
responsibility.
The Commercial Exhibit at the Atlantic City
Meeting
All of the delegates in attendance at the
Twentieth Annual Convention of the American
Hospital Association recently held in Atlantic
City who took time to study the commercial ex-
hibit with any degree of thoroughness will con-
cede that it formed an exceedingly interesting and
instructive part of the convention. Far from be-
ing a "side-show," it was an important integral
part of the convention, without which the con-
vention would have been greatly impoverished.
Members who failed to visit the various exhibits
and ply the exhibitors with questions missed a
real opportunity to inform themselves of the
most recent advances in hospital construction and
equipment.
The importance of the commercial exhibit lies
partly in the fact that it puts delegates in touch
with the latest devices and methods which make
for economy and efficiency. Suppose that your
laundry equipment is out of date and that you
are considering the installation of new, and per-
haps additional, equipment. Or, suppose that
some friend has given your hospital money to
purchase labor-saving devices for the kitchen.
Where could you find a better place to give care-
ful consideration to the question of the best type
of equipment to be installed than at the com-
mercial exhibit? Here you can see the product
itself and can handle it and inspect it closely.
If it is a mechanical device, you can examine its
mechanism and have an actual demonstration of
how it woi'ks instead of having to depend merely
upon a written description, which is seldom
wholly satisfactory. The exhibitors, moreover,
are always glad to explain technical points that
may be difficult to understand unaided. These
exhibits enable you to make a comparison of
products and to choose on the basis of merit.
Members of the association do not need to
have their attention called to the fact that the
commercial exhibit is one of the association's
chief sources of income. From this standpoint,
assuredly, the commercial exhibit is important
and should have the interest and support of all
the members of the association in attendance at
the convention. The exhibit can continue as a
source of income only if the members devote a
reasonable amount of time to an examination of
the various exhibits and give the exhibitors an
opportunity to present the character and merits
of their merchandise, irrespective of whether or
not they happen to be in the market for the ex-
hibitor's particular product.
If the commercial exhibit is to be regarded as
an important, integral part of the annual conven-
tion of the association, every efll'ort should be
made to develop it and to make it as interesting
and instructive as possible. The trustees of the
association, through the committee on the com-
mercial exhibit, should consider carefully what
needs to be done in order to induce more manu-
facturers to exhibit on these occasions. Careful
consideration should be given to the question of
what conditions should prevail as to space for the
exhibits and their location with reference to the
main meeting-hall of the convention. In selecting
the actual hotel at which conventions are to be
held, consideration should be given to the de-
sirability of the space available for the exhibit.
The association itself may well consider how it
can contribute to the attractiveness of the exhibit
over and above the efforts of the individual ex-
hibitors to make their own exhibits attractive.
A number of exhibitors and delegates of the
recent convention expressed regret that certain
specific periods were not set aside each day ex-
clusively for the examination of the com.mercial
exhibit. With the possible exception of one even-
ing, delegates could use only the odds and ends
THE MODERN HOSPITAL
389
of theii- time between sessions to visit the ex-
hibit unless they were willing to forego some of
the sessions of the convention. To carry out
this plan, it may be necessary to place definite
limits upon the time which the various speakers
may have, and to have the chairman of the vari-
ous meetings see that these limits are strictly
adhered to.
A Nation-Wide Survey of Nursing Resources
The American Red Cross, which is by army
regulations the reserve for the Army Nurse
Corps, has been asked by Surgeon-General Gorgas
to conduct a nation-wide survej- of nursing re-
sources. It will be remembered that some time
ago the War Department made a requisition for
twenty-five thousand nurses for war service by
January 1, 1919. This requisition is certain to
be tremendously inci-eased before the summer of
1919, if the war continues. Up to August 1, 1918,
the Red Cross had assigned over thirteen thous-
and nurses to service. In order that a sufficient
number of graduate nurses may be withdrawn
for military service with the least possible detri-
ment to the interests of the civil population, the
Red Cross is now asked to conduct a survey to
ascertain the number of graduate nurses, both
registered and nonregistered, in the country;
also the number of pupil nurses, ungraduated
nurses (women who left training school before
completing the course of training), trained at-
tendants, practical nurses, midwives, and w-omen
who have taken Red Cross courses. The survey
will also show any special qualifications possessed
by nurses, as the ability to speak some other
language than English.
In the "Handbook of Information," issued by
the Red Cross on the subject of the survey, it
is suggested that graduate nurses employed in
homes to care for minor ailments or to look after
the general comfort and convenience of the house-
hold might well be replaced by semi-trained
nurses ; that many ward duties in hospitals and
much routine work in dispensaries could be per-
formed by attendants ; and that the clerical
assistant in the superintendent's office of civil
hospitals need not, at least in war times, be a
trained nurse.
The work is to be conducted by the Red Cross
through its nation-wide organization of chapters
and branches. As a single form of questionnaire
is to be used in all parts of the country at the
same time, and as all questionnaires are to be
forwarded immediately from the chapters to di-
vision headquarters and thence to national head-
quarters, national tabulation of all essential facts
will be made possible.
Experience has proved that knowledge of our
own resources is one of our most imperious needs.
As mentioned in the handbook, "while the pro-
posed survey is intended primarily to meet the
existing emergency and the demands of the im-
mediate future, it will also prove of inestimable
value in the event of the war continuing for a
period of yeai's and in reconstruction work dur-
ing and after the war, particularly if it is kept
up to date by the addition of fresh information
from time to time." We have as yet only begun
to realize dimly the tremendous task of recon-
struction and reorganization which awaits us
even if the war should end soon. To meet the
demands which will be made of it, the nursing
profession, as well as the medical profession,
must be more highly and more completely or-
ganized. The first step toward this organization
is to obtain that knowledge of itself which this
survey proposes to furnish. The task with which
the Red Cross has been entrusted is indeed a
momentous one, and the results will no doubt
be commensurate with the aim.
Increased Supply of Surgical Needles Soon Avail-
able— Conservation Still Necessary
We are asked to give publicity to several im-
portant communications from the section of medi-
cal industry of the War Industries Board.
In the first place. Col. F. F. Simpson, chief of
this section, has good news for surgeons in the
fact that an increased supply of surgical needles
will soon be available for civilian needs. He sug-
gests that, in order that manufacturers may ar-
range to take care of civilian needs without preju-
dice to war contracts, orders for surgical needles
should be placed through the accustomed sources
of supply for deliverj- as early as practicable. The
sizes and varieties of needles available are at
present somewhat limited because the manufac-
ture of needles in this country is still on a some-
what experimental basis. A chart showing the
sizes and kinds of needles most readily obtainable
at present is furnished by the section on medical
industry.
Conservation is still most necessary, and the co-
operation of hospitals is earnestly requested
toward this end. They are asked to aid in reliev-
ing a very serious condition by expediting as much
as possible the return of empty nitrous oxide and
oxygen cylinders to the point of refill. Hospital
staffs are requested to limit as far as possible the
use of supplies such as drugs, cotton, gauze, ad-
hesive plaster, suture materials, surgical instru-
ments, gloves, and other rubber goods. Every
doctor and dentist in the country, moreover, is
390
THE MODERN HOSPITAL
urgently requested to go carefully over his instru-
ments and pick out every scrap of platinum, no
matter how small and no matter in what condition,
that is not absolutely essential to his work. There
are two channels through which these bits of
platinum may reach the government; they are
the Red Cross and the banks under the super-
vision of the Federal Reserve Board. Properly
accredited representatives of the Red Cross will
soon make a canvass for the purpose of collecting
platinum that anyone may desire to donate, and
all are warned against giving scrap platinum to
any collector who is not provided with proper
authorization to represent the Red Cross. The
banks mentioned above will pay current prices for
platinum. The War Industries Board recognizes
that platinum is required in certain necessary
surgical and dental instruments, but hopes that
all physicians and dentists will use substitutes
wherever possible.
and help of all kinds, and to distribute these requests to
various centers where the city resources are being organ-
ized. This bureau is practically dependent on the services
of hospital social workers, loaned by the departments of
many hospitals. School teachers, also, and other profes-
sional women are helping in this work. Social agencies
of the city are combining, each one doing some part of
the work involved in fighting the epidemic and caring for
its victims. Neighborhood service is being organized, and
the people instructed in measures of protection of health
and care of the sick at home.
Social service is becoming organized with
definite professional standards and a definite field.
The foregoing letter suggests how important it is
destined to become in the near future.
Social Service and the Influenza Epidemic
A communication received from Miss Mary
Antoinette Cannon, Director of Social Service,
University of Pennsylvania Hospital, is of so much
interest that we print it entire:
The epidemic of influenza now in progress in this coun-
try has entirely changed for the present the course of
hospital social work. Ordinary forms of social work are
suspended in many hospitals, and only emergency work
is done.
The Boston Social Service Department, in addition to
work in the hospitals, has lent workers to the Boston
Nursing Association and has organized medical social
workers to assist the nurses in social problems, such as
provision for neglected and orphaned children, and con-
valescent care of families and relief in the homes. The
emergency health subcommittee of the State Committee
of Public Safety has organized canteen service for food
motor service and has inaugurated a campaign for re-
cruiting helpers for nurses. The hospital social workers
have submitted to this committee a plan for medical social
service.
In New York, as elsewhere, the hospitals are suffering
from lack of nurses. Bellevue Hospital, which has seven
hundred cases of influenza and many sick nurses, is using
its social workers in nursing in the wards. The social
service department has secured the use of motors to take
early convalescents home and is opening quarters for
sixty convalescent children near the hospital, as well as
accommodations for well children whose mothers are ill
in hospitals.
Philadelphia has opened eight emergency hospitals to
take the overflow from the regular hospitals. All of these
emergency hospitals are filled, and more are being opened
as fast as they can be manned. Hospital social workers
are helping the nurses in some of the emergency hospitals
and in many of the regular ones. Some of the woi'kers
have given their services to the Visiting Nurses Society.
A Bureau of Influenza Information has been organized by
the Council of National Defense to receive requests for
nurses, doctors, hospital care, burial service, ambulances
Death of Mrs. Warner
As we go to press, we are informed by Dr.
Bailey, assistant superintendent of Lakeside Hos-
pital, of the death of Mrs. Warner, wife of Dr.
Andrew R. Warner, superintendent of Lakeside
Hospital and president of the American Hospital
Association. Mrs. Warner died on October 25, of
a very extensive pneumonia following an attack
of influenza. We know that we are expressing
the sentiments of the entire hospital profession
in extending to Dr. Warner our sympathy in his
bereavement.
THE LATCHSTRING OUT
Friends of The Modern Hospital are especially invited
to call at our offices when in town and to bring us any
items of news in regard to their institutions or their
communities.
Dr. Donald E. Baxter, who, it will be remembered,
resigned the posts of director of the New York Commit-
tee for the Prevention of Infantile Paralysis and Eastern
editorial representative of The Modern Hospital in order
to assume the position of chief of the bureau of tubercu-
losis of the American Red Cross in France, passed through
Chicago recently on his way to China, whither he goes to
become superintendent and general manager of the China
Medical Board of the Rockefeller Foundation.
Major Baxter says that French hospitals are well worth
the study of American hospital administratoi's. We are
rather accustomed to the fond belief that American hos-
pitals are absolutely the last word; yet Major Baxter finds
that the French are five or ten years ahead of us in many
ways. Their nursing sei'vice is not equal to ours, because
their nurses are not drawn from a class which is socially
equal to that which supplies our nurses. The French,
notwithstanding, get good results from their nursing ser-
vice.
Mr. Frank E. Chapman, superintendent of Mount
Sinai Hospital, reports that his institution has leased an
entire apartment building, consisting of eighteen suites for
the purpose, primarily, of furnishing additional facilities
for caring for nurses, thus permitting of a larger enroll-
ment of nurses; and secondarily, to permit the increasing
of hospital facilities by devoting the space now occupied
THE MODERN HOSPITAL
391
by nurses to hospital service. By this move, the capacity
of the hospital will be increased about seventy-five beds.
In order to meet the need of the country for graduate
nurses, says Mr. Chapman, the Cleveland League of Nurs-
ing Education in cooperation with Western Reserve Uni-
versity, organized a special summer preparatory course of
ten weeks for students wishing to enter Cleveland schools
of nursing. The Mayor's Advisory Committee of Cleve-
land, recognizing the value of such a course, appropriated
the necessary funds as a war emergency. Applications
were made through recognized schools of nursing of
Cleveland or directly to the registrar of the course. The
nursing section of the Women's Committee of the Council
of National Defense also helped in recruiting. The hos-
pitals of Cleveland cooperated to the extent of furnishing
room, boai'd and laundry for all those who were to enter
Cleveland schools of nursing, otherwise students had to
provide their own living expenses. All students paid for
textbooks, laboratory fees, etc.
The course was open to college women and high school
graduates. Despite the fact that very little time was
given to publicity, 101 students signed up for the course,
eighty-eight of whom reported on the day of registration.
Of this number, seventy-six completed the ten weeks.
Four of tiiese students expect to enter an Army School of
Nursing; the others are now completing their three years
in several of the schools of Cleveland. The character of
the work was similar to that given at Vassar College this
summer, except that no nursing procedures were taught.
It consisted of intense theoretical work in the sciences
which form the foundation for nursing. The pupils who
have taken this course will be able to advance more
rapidly in their work in the hospitals and will be better
able to meet any war emergency that may arise.
"We do not feel," adds Mr. Chapman, "that such a
course may be held up as ideal, but this movement toward
centralization of theoretical training for nurses is in line
with the thought of the leading nursing minds in this
country, and it is hoped that the success of this summer
course will be such as to warrant the establishment of
permanent courses of this character in connection with the
leading universities throughout the country."
THE MEMOIRS OF A HEAD NURSE
Warning to Hospitals
It has come to the knowledge of The Modern Hospital
that a certain photographer has recently presented him-
self at an eastern hospital, claiming to have been sent
by this magazine to make photographs of the institution,
and that after taking certain photographs he collected
a considerable sum of money for prints which he agreed
to fui-nish the hospital but which, after more than three
months, he has failed to deliver. No such person has ever
been employed by us, or in any way authorized to repre-
sent us. Anyone in our employ, who may be assigned to
visit a hospital for any purpose is furnished with unques-
tionable credentials, which the hospital authorities have a
right to demand, and no hospital is ever asked to pay for
photographs which we may request the privilege of mak-
ing.
On the magnificent estate of Sarisbury Court, near
Southampton, there is being built the largest American
military hospital in Great Britain, planned to accommo-
date nearly 3,000 wounded soldiers from the western front.
The central building of the hospital will be the old manor
house, erected as a private residence 35 years ago by a
wealthy British land owner. Around this the American
Red Cross is building nearly ten acres of frame hutments.
VI. Told at the Coffee Party— The Head Nur.'ie's Story,
Showing That What We Sow We Reap in Plenty —
Also That What We Admire at Twenty, We
Can't Even See Fifteen Years Later
Every girl who has lived in hospitals and nurses'
homes knows the coffee party as an institution. Repeated
menus, quantity cooking, a continuous diet of canned
goods, and meals that have to be always planned econom-
ically lose their flavor in time for hospital workers, and
the girl student nurses and supervisors — and superin-
tendents, too — have feasts in the privacy of their own
rooms.
Coffee is always the piece de resistance — real coffee,
made with egg and plenty of ground coffee and boiling
water, and with plenty of cream to put in it — real cream.
The rest of the menu varies. Sometimes it is sandwiches,
dill pickles, and cake or doughnuts, sometimes the con-
tents of a box from home; and sometimes, when it can be
arranged without creating too big a scandal, bacon and
eggs is the main dish. Everybody wears "undress" uni-
form, usually a kimono. Comfort rules rather than cere-
mony. Everybody sits around on chairs, beds, floor, or
anywhere else available in a small room. The cooking
is done on a small alcohol stove or an electric grill —
or both.
The party that begins this story consisted of the oper-
ating room supervisor, the supervisor on corridor E and
the one on the third floor, the red-headed dietitian, a new
post graduate (a guest for the first time) and was com-
plete except for the head nurse, who was late in getting
over from the hospital. Finally she came in, gray in the
face with exhaustion, but cheery as ever. "I am so tired,"
she said, "I could die just to get a good rest, to know that
no one would ever wake me in the morning again. Any
man who wants a good cook, a good nurse, and a patient
wife can have me for the asking."
"Cheer up. Bob," said the red-headed dietitian, "the
worst is yet to come. When you get on the outside of
two or three cups of coffee and some of this coffee cake
from Meyer's bakery, you'll feel like another woman.
What kept you so late?"
"Oh, nothing much," said the head nurse. "Mrs. Sey-
mour, up in Ward 3, just had another pair of twins. She
had the first pair last spring. She is a regular spring
customer up in the obstetrical ward. You know the
woman I mean — the one with short, bleached hair, untidy
and unintelligent. She is always making excuses and
never has any clean clothes for either herself or the baby.
Besides her being one of these useless and naturally un-
tidy women, they really haven't anj'thing, you know.
That's what she gets for marrying a handsome church
tenor."
"A handsome church tenor!" shrieked three voices at
once. "You don't mean that fat, greasy husband of hers
that comes to see her? Tell us about it!"
"I certainly do; that fat, greasy husband, as you call
him, was one of the handsomest men you ever saw fifteen
years ago, the leader of the choir at Grace Episcopal
Church, the richest congregation in the city. At that
time he was engaged to Miss Grace Crewes. Her father
was a pillar of the church then, and they had slathers of
money She fell for his solo singing, and he for her
father's money. Not a very good combination, you'll
admit. You can't keep house on tenor solos, and she
had too much sense and character to want to be around
392
THE MODERN HOSPITAL
a would-be opera tenor for three hundred and sixty-five
days a year after the veneer had worn off.
"I met them just after I had graduated. I came back
into the hospital for a ease, and Mr. Seymour was the
case. Bad appendix or something, I've forgotten just
what. Miss Crewes was terribly cut up over him at that
time. Thought, of course, that he was crazy about her,
but anyone could see that he never could be crazy about
anyone but himself. You know the kind. Thought all
he had to do was to go down to New York, and the direc-
tor of the Metropolitan Opera House would beg him to
sing the leading roles in grand opera. My patient's
room was filled with so many flowers I almost grew to
hate them. It was a whole morning's work to take care
of them. And the girls and women in town who sent the
flowers and jellies and custards and aff'ectionate notes
would make you ashamed of your sex.
"I had not been on the case very long before I could
see that Seymour was playing someone else besides his
fiancee. The other was a little bleached blonde tawdry
thing, playing a small part in a stock theater company
at the Grand. She had been taking lessons of him. I
remember she always wore a big black picture hat with
dirty yellow plumes on it when she came to see him. I
worried the soul out of me, fearing that fine girl of his
would come in some day and find him spooning with his
chorus girl friend. They were not particularly careful
whether people saw them or not, and I knew that, sooner
or later, something was going to happen — and happen it
did, sure enough.
"One day Miss Crewes, his fiancee, came in while the
other one was there. She always walked softly, and she
stood in the doorway some time before they saw her. The
girl with him was perfectly brazen about it. She just
tossed her head as she went out and said, 'He wouldn't
want you at all if it weren't for your money. He told
me so!' Miss Crewes just stood looking at him. She was
as white as the white tiles in the operating room, but
she was game. The real people with her breeding always
are, you know. She came over to the bed.
" 'Is that true, Clarence?' she said. 'Do you really care
more for this girl than you do for me?'
"He was like a peevish child that had been caught
stealing jam. 'For heaven's sake,' he said, 'don't make a
scene. I have my career to think of. Of course, I knew
that you and your father would help me to get the right
start in New York. It's only natural for a fellow to get
engaged to someone that can help him, isn't it? Of
course I like Millie, and I'm not going to turn her down,
either. For that matter, my voice will be recognized
when I get to New York and I can take care of myself
and her, too, if necessary.'
"I don't remember that she even answered him. She
just turned and went out, and, of course, that was the
last he ever saw of her or her father's money. I heard
that she was sick after that and that her people sent her
to travel. She was terribly hurt, and I suppose it took
her some time to learn to be thankful it happened that
way.
"He did go down to New York, but the managers on
Broadway didn't run after him to sing leading roles.
Nothing like that happened. His sisters, who were teach-
ing school, went without things they needed to pay his
bills while he walked up and down Broadway, twirling
his moustache and his cane, talking about himself and
hanging around the agents' offices until he found a forty-
dollar-a-week job with a fly-by-night stock opera com-
pany.
"After a while his family got tired of sending the best
part of their salaries in answer to urgent telegrams and
special delivery letters. So he married his chorus girl
and finally came down to a place in the chorus himself,
and they shared their eighteen dollars a week when they
worked, which was spasmodically.
"A few years ago they came back here, and he has
done a little of everything — sold pianos and victrolas on
the installment plan and collected ten-cent insurance pre-
miums. I heard all about them from one of the school
teacher sisters.
"Well, I started out to tell you about what happened
today and ran off my text. You know that we have
needed a new wing for the maternity and children's
wards for some time, and the board of trustees have been
trying to get the moneyed people of the tovioi interested
about it. You know the Mansfield's. They own the
street-car company and the telephone company and most
everything else around here. They came to the hospital
today to look over the place with a view to giving a few
hundred thousand for a new building. Mrs. John Mans-
field— she was Miss Crewes in the early part of my story
— and her husband were with the president of the board
and the superintendent. As luck would have it, just as
they came through the swinging doors into the maternity
corridor, there sat Clarence Seymour on the anxious
bench waiting to go in to see his wife. You know what
a greasy, untidy-looking thing he always is — and he
looked woi'se than usual today. He was half asleep.
His mouth was open, and his hands folded over his fat
stomach. Under one arm was a newspaper bundle with
some half-washed nightgowns and baby clothes sticking
out of it. He awoke with a start just as they came in
front of him. Talk about retribution! Her eyes rested
on him for a minute, as they would if they were taking
in a piece of furniture or a detail of a room she was
passing through, and then they passed beyond him as if
they saw nothing, and the group went on through the
corridor.
"Which all goes to show," said the head nurse, as she
ended her story, "that what we admire at twenty, we
can't even see fifteen years later in life. More coffee and
a sandwich and another pickle, please."
Quick Action of Red Cross in Influenza Epidemic
Illustrating the rapidity of the Red Cross to act in time
of emergency at home as well as on the battle field, is
the following item:
Last Wednesday at four o'clock Everett Beckwith of
Aurora, Illinois, Red Cross Field Director at Camp Grant,
called up the Central Division of the Red Cross via long
distance 'phone, requesting as many ambulances as could
be spared to handle the Spanish influenza epidemic situa-
tion at the camp. Inside of an hour the Bureau of Mili-
tary Affairs at Central Division had recruited for the pur-
pose five ambulances, which, with their drivers, some be-
longing to the Red Cross Motor Corps in Chicago, others
coming from various nearby points throughout the state,
were speeding on their way to the scene of trouble.
Don't Forget to Save Those Fruit Pits and Nut Shells
It has been discovered that by putting fruit pits and nut
shells through a certain process, carbon necessary in the
manufacture of gas masks can be made. Remember that
thousands of these gas masks must be sent to our men in
the trenches and that every fruit pit and nut shell will
help. Also remember that you will facilitate matters by
drying the fruit pits.
THE MODERN HOSPITAL 393
PAPERS READ BEFORE THE AMERICAN HOSPITAL ASSOCIATION
Some of the Interesting and Important Articles Presented at the Twentieth Annual
Convention
Canada's Rehabilitation and Reconstruction Work
By T. B. KIDNER, Vocational secretary of the Invalided Soldiers'
Commission of Canada*
I felt very much honored when your association asked
me to take part in your program, but I must say that it
seems to me you have heard quite enough on this side of
that in%'isible international boundary line as to what your
neighbors and cousins on the North have done in this con-
nection. For a number of reasons the work which Canada
has done has been vei-y closely observed by our friends in
the United States, many of whom it has been my duty
and pleasure to welcome when visiting Canada for that
purpose. I may further say that we consider it a great
honor to Canada that some of the methods which we were
able to work out up there are being adopted by the United
States, now that the problem of rehabilitation of its own
•disabled men is before it.
Three years ago last summer our disabled men began to
come nome, and possibly I cannot do better than to out-
line briefly the several steps to provide for the manifold
and complex needs of the disabled which were taken as
the necessity for each appeared.
First of all, a commission was formed to provide con-
valescent hospitals, and very soon a string of these was
established from the Atlantic to the Pacific. They were
of various t\-pes; some were pi-ivate dwellings which had
♦been placed at the disposal of the Government by patri-
otic citizens, and some were buildings belonging to other
branches of the Public Service, which were turned over
for the use of the Hospitals Commission. These served for
a time, but before long it became apparent that impro-
vised and altered buildings would not suffice. As time
went on, men were sent back from overseas much earlier
in their hospital history, and hence it came about that the
commission had to undertake the provision of hospitals
with facilities for active treatment as well as for mere
convalescent work. Special types of buildings were de-
vised and erected at various points throughout the coun-
try. The buildings were of substantial type, but not per-
manent in their nature. They were, of course, built to
meet the rigors of a Canadian winter and have served
their purpose splendidly. In this connection, it may be of
interest to nole the opinion which I have heard expressed
by a number of pi-ominent medical men that possibly
large city hospitals will, in the future, be planned more
on a temporary basis. As one man put it: "I do not think,
after our experience of these temporary hospitals both in
Europe and in Canada, we shall be likely to put so much
money into bricks and mortar as in the past. Many of
our magnificent city hospitals in America have now, by
the growth of the cities, become surrounded with manu-
facturing and other undesirable buildings. If buildings of
a more temporary character had been devised, it might
have been possible to scrap them after, say, fifteen years'
service, and erect new buildings with more ' up-to-date
facilities and a little further out from the heart of the
citv. The increased value of the original site would prob-
Mr. Kidner is now on duty in Washington with the Federal Board
for Vocational Education, having been loaned to the United States
Government by the Canadian authorities for a period of six months, to
assist in the rehabilitation work for disabled American soldiers and
sailors. The Federal Board for Vocational Education is the body
charged under the Vocational Rehabilitation Act of June 27. 1918, with
the provision of vocational re-education for disabled
discharge from military and naval service.
after their
ably go a long way toward meeting the cost of a new
building of a temporary or semi-permanent type."
The next step which had to be taken was to provide for
the placement in civil employment of men who had been
discharged, after their rehabilitation was completed. An
excellent scheme of cooperation between the Federal gov-
ernment and the various provincial governments was es-
tablished, and in each province an employment commis-
sion, each of which has done excellent service ever since,
was appointed.
The next step undertaken was the provision of voca-
tional reeducation, and in this we were entering an almost
unknown field. Outside of a little information as to what
France was doing and a few reports from Germany, there
was practically nothing upon which to base any scheme.
A survey was therefore made of our returned men, and
several very interesting facts were revealed. First, we
learned that the number of men who were so seriously
disabled as to be unable to return to their former occu-
pations was comparatively small. Of course, only the
more seriously disabled are returned to Canada, but of
these it appeared that only about ten per cent would
require training for new occupations because of their dis-
abilities incurred in service. Up to the present, in Can-
ada, this percentage has been slightly exceeded, but pos-
sibly this is due to the fact that the commission has
always interpreted the regulations in favor of a disabled
man if any doubt existed as to his eligibility for reedu-
cation.
Another interesting fact which appeared was that com-
paratively few men had suffered the loss of an arm or a
leg. Up to the end of April, 1918, out of about twenty-
eight thousand invalids returned to Canada, only about
fourteen hundred had suffered a major amputation. Also,
remarkably few men are blinded. An official statement
from Ottawa made only about one month ago gave the
number of blinded Canadian soldiers to date as forty-six.
At the time the Hospitals Commission (now the Inva-
lided Soldiers' Commission) began its vocational reedu-
cation work early in 1916, there were about one thou-
sand men under treatment in convalescent hospitals in
Canada; and it therefore appeared that the problem of
reeducating those men who were so seriously disabled
that they could not return to their former occupations
was not a serious one in point of numbers, considerably
less than one hundred men apparently being likely to
need it. There did seem to be a need, however, for some
training for all the men, and the commission decided to
provide opportunities for all men undergoing convalescent
treatment to undertake some form of occupational work.
It was pointed out that this would have a three-fold value:
(1) In the opinion of many medical men (may I say today,
ladies and gentlemen, all medical men), such work would
have a distinct therapeutic value. (2) It would have a gen-
eral disciplinary value in an institution, but it would also
be valuable as self-discipline for the individual, and would
prevent his hospitalization and consequent deterioration
from an economic and moral standpoint (3) It was felt
thit, in many cases, training given a man during his period
of convalescence might result in an improvement of his
earning capacity upon his return to civil life.
Our beginnings were very modest. Usually, we fitted
394
THE MODERN HOSPITAL
up some classrooms for general studies, a simple work-
shop of the arts and crafts type, and, wherever possible,
we also introduced gardening and poultry work. This
was gradually extended until, in connection with each
convalescant hospital, a wide variety of opportunities were
provided so that every disabled man, subject, of course,
to medical supervision and direction, could undertake
some form of activity, mental, physical, or both, which
would be helpful to him. Among the many things which
he have tried to do in Canada for our disabled men, I feel,
personally, that this has not been the least important.
In the spring of 1917, thanks to the provision of some
excellent hospital ships, our disabled men were brought
home much earlier, and active treatment hospitals had
to be provided. This involved the introduction of "ward
occupations," as we term them, in which various forms
of light hand-work, and sometimes general educational
work, were provided for the men who were either con-
fined to bed or unable to leave the ward. Today, although
certain changes in the medical and military administra-
tion of the hospitals have been made, the three stages of
the work of vocational rehabilitation are still carried on
by the Invalided Soldiers' Commission, and may be stated
as follows: (1) ward occupations, which are provided
for men undergoing active treatment; (2) the curative
workshops, wherein men in the convalescent stage engage
in a variety of occupations; (3) the vocational or indus-
trial reeducation for some new occupation, which is under-
taken after a man has received his military discharge.
Time will not permit me to into further details of the
vocational work, as I wish to speak of some other steps
which had to be undertaken as the needs developed. It
is perhaps worth mentioning that, as far as possible,
every kind of auxiliary treatment, such as mechano-
therapy, hydrotherapy, and electrothei-apy, was also pro-
vided. I want to mention in particular, however, the
functional re-education, which is a very important division
of the work.
As a layman, it seemed to me that one of the most
interesting features of this work was the development
of many simple devices for the individual man rather than
the use of elaborate mechanical apparatus on which so
much money has been expended during recent years by
many hospital authorities. Of course, I do not pretend
for one moment to speak with authority on this, for I
have always been connected with vocational education,
but it does seem to me that simple apparatus which can
be made at the cost of a few cents for materials, and
often made, if not by the sufferer himself, by one of his
fellow-sufferers, will in nine cases out of ten be more
effective than elaborate, costly mechanical apparatus,
such, for instance, as the Zander machines.
The question of artificial limbs was another one which
received the serious attention of the Hospitals Commis-
sion, which decided to establish its own limb factory and,
as far as possible, to standardize the limbs. Fortunately,
the proportion of leg amputations to arm amputations
is about two to one. As many of you know, probably
much better than I do, the question of a satisfactory
artificial arm is most difficult one, and while the Gov-
ernment artificial limb factory in Toronto has produced
some very valuable and useful attachments, I do not think
that they would claim to have reached finality in the arti-
ficial arm. I do think, however, that the standard arti-
ficial leg now being provided for the Canadian soldiers
will take a lot of beating.
Other matters have had to be taken up by the Cana-
dian Government, such as the problem of land settlement.
A Soldier Settlement Board has been appointed, and a
number of cases have been dealt with, although from the
nature of the work it does not seem probable that many
disabled men will be able to undertake agriculture as a
livelihood, except in a few of its lighter forms, and to
some extent in connection with the increasing use of farm
machinery, tractors, etc.
I have not touched on the social side of the problem
of reconstruction, but this has been well cared for in
Canada. Indeed, every agency, public, semi-public and
private, has cooperated in this great problem of the reab-
sorption of the disabled men into civil life. It is a big
job and worth all the thought and all the heart that we
can put into it. We must, however, preserve a just bal-
ance between sympathy and duty. We must not spoil
our returned men by adulation and hero-worship. On the
other hand, neither must we neglect any step which can
assist in restoring the disabled man once more to useful-
ness, and, therefore, self-respect and happiness. By the
passing of the Vocational Rehabilitation Act the United
States has shown that it fully realizes that pensions and
medals are not sufficient, but that it is the duty of the
nation to aid those disabled in the nation's service to
realize that the joy of life may still exist for them and
that the greatest happiness comes from service — happi-
ness for themselves and for the community.
The Management of the Dietary Department of the
Hospital
By lulu G. graves. President, American Dietetic Association, Editor
Department of Dietetics. The Modern Hospital
The noticeable feature of the dietary departments of
many of our hospitals is their lack of management. Some ,
sort of routine is necessarily established in the kitchen,
and each individual fits his work into this routine in
order to meet the requirement which is given great em-
phasis in every hospital, namely, serving meals on
scheduled time. The importance of having prompt service
of meals, both to patients and people who are well, is
perfectly obvious, and no one would attempt to under-
estimate the necessity of it; however, the promptness
should be invariable — morning, noon and night — day
after day. This invariable promptness can be best as-
sured only as a result of a carefully planned system of
working, wherein each piece of work and each individual's
part fits into the whole scheme in such a way that
having everything done when it should be done is an
inevitable result of the combined efforts of the whole
department. Too often getting the meals out of the
kitchen is the chief objective, an end to which every-
thing else must be sacrificed; and usually much is sacri-
ficed under such conditions. The time and efforts of the
employees are not utilized to the best advantage and
food is wasted in varying amounts, because the amounts
to be served and the care of the food are secondary con-
siderations.
The dietary department is the only department in the
hospital which is concerned with every one in the or-
ganization. The nursing department and the physicians
have to do with the patients, and their care; the office
employees, with the details of business; the housekeeper
has her force of cleanei-s, laundry workers, etc, to look
after still other matters. But whatever their point of
contact with the hospital, every one in the organiza-
tion eats. I believe it is not too much to say that
the reputation of a hospital depends as much upon
its food service as it does upon any other service it
renders. It is to be expected that people who are ill
THE MODERN HOSPITAL
395
do not have normal appetites, and attention should be
given to the food of these patients as well as to those
who are being treated by dietotherapy. If patients are
pleased with their food, they are very apt to speak
well of the hospital after they leave it, but if they are
not satisfied with this service, they are sure to speak
ill of it. It is too much to expect that nurses and doctors
will speak well of their food — particularly after they
have been at the hospital a year — but it is, nevertheless,
essential that they should be adequately fed. Because
their w'ork is strenuous, they should have food that is
nourishing and cooked in such a way that it is palatable
and easy of digestion; because of their habits and en-
vironment, their menus should have variety and their
service be as pleasing as possible. These things play a
large part in the happiness as well as in the health of
the nurse while she is in training. Much the same thing
might be said of the food of employees as has been said
of that of the nurses and interns, though the plan should
be executed in a different way.
This department involves the expenditure of a large per-
centage of the money spent in hospitals. In business
organization, the departments requiring the greatest
expense are given the greatest attention and are put
under systematic control. The contrary, however, is
true in hospitals. The dietetics department of the hos-
pital, which is of so much importance, is frequently given
no attention by anyone with authority.
It is useless to take time here to discuss that which
is so well known with reference to the undesirable loca-
tion of many kitchens and storerooms and their incon-
venient arrangement, as these are generally conditions
that cannot be changed except by rebuilding or extensive
remodeling. But the very fact that they can not be
changed makes it all the more desirable that, in spite
of these obstacles, intelligence and judgment be used
in getting the best possible results.
One way of doing this is to organize the entire de-
partment under the supervision of one person. This
concentrates the responsibility and forms a base upon
which to build a compact and durable structure. With
one person's interest extended equally to all parts
of the system, they will all be developed and managed
equally well.
Take, for example, the hospital having a steward or
purchasing agent who buys the food materials and,
nominally at least, has supervision of the main kitchen,
the diet kitchen being in charge of the dietitian. The
. steward may buy very economically and judiciously;
in some rare instances he may even give thought to
variety in the menu; but how many of these men take
any thought of this food material after it reaches the
kitchen? He may be interested in having the meats
served rare or well done — for, with all stewards, whether
of hotels, clubs, or hospitals, meat is the chief considera-
tion— but does he gi%'e any attention to the method of
cooking, as to whether valuable food principles are re-
tained or lost? Is there any diflference in the method of
cooking meat for use as meat, and that of cooking meat
for the broth? Are the mineral salts in the vegetables
dissolved into the water in which they are cooked an(i
the water thrown away, or are vegetables cooked in such
a way that the salts are utilized? Does he give any
thought to the way in which food is sent out from the
kitchen to be served in other parts of the house, and
make provision for that which is not used to be kept
clean and in good condition to be utilized later when
it returns to the kitchen, if it does return? Does he
take into consideration the working conditions of the
kitchen, keeping the utensils and equipment in good
repair, and both the kitchen and storeroom clean and
sanitary? Quite naturally, if no one else takes an
interest in caring for these things, the kitchen employees
will not do so. Doubtless we are all familiar with
kitchens in which utensils are used which are not safe
to use and in which one may find corners, plumbing
atrocities, and other conditions which should not exist
under any circumstances where food is being prepared,
and which could not exist if the City Health Department
were highly efficient.
In the opinion of the steward, these are minor details
to which he gives no time; if one is fortunate enough
to have a cook who will give attention to these things, the
situation is much improved, but a cook who looks after
details of cooking and cleaning has little time for any-
thing else; consequently, some other feature is apt to
be neglected.
With the steward in charge of the main kitchen and
the dietitian in charge of the diet kitchen, we have two
distinctly separate kingdoms, between which, all too
frequently, there exists, if not a state of war, at least
active hostilities, or at best only the observation of diplo-
matic relations. This means two sets of supply rooms
or cupboards, two ice-boxes, and, to some extent, a dupli-
cation in cooking. This in itself is extravagant, for,
naturally, the more scattered the base of supplies, the
less the opportunity for conservation; and whenever this
situation prevails, there is not the careful interchange
of supplies between the two kitchens that there would be
if both were under the same supervision. For instance,
the main kitchen may have left in its supply enough
meat, vegetables, fruit and dessert for two or three
servings. As it is not enough to serve the patients of
any ward, and is consequently of no use, it is either
thrown away or eaten by kitchen employees who happen
to be at hand — not as a part of their regular meal. We
all know the frequency of such occurrences. Then why
not have a system in which these small portions of food
could be used in the diet kitchen for special diets or
special orders, or served to some one whose appetite needs
catering to in the form of a salad, a sandwich, a chowder,
or a casserole? This not only saves small portions of
food material, which in time aggregate large amounts,
but it also teaches the nurse different methods of utilizing
food in appetizing ways — a lesson which will be of great
value to her when she begins private nursing.
Again there is the question of service. Generally, if
the serving in the wards is supervised at all, it is
done by a ward nurse or the dietitian. A nurse who
will take an interest in saving food material in a hos-
pital is so rare a specimen that she may be left out
of the discussion. Yet, if the duty of conservation falls
upon the dietitian, she has no authority to regulate
methods of serving in the main kitchen. It is the cus-
tom of most cooks to send a certain definite amount of
food to each wai-d, regai-dless of changes in diets or
changes in number of patients in the ward. One remedy
for this is to have a bulletin board conveniently placed
in the kitchen, on which is written each evening the
census of the several wards as given by the head nurse
late in the afternoon. The cooks could go over this
before beginning work for the following day and thereby
judge of the amount of each kind of food needed. Ladles,
spoons and dippers should be provided and the cooks
taught to determine how many servings each will hold
of soup, mashed vegetables, coarse vegetables, and other
396
THE MODERN HOSPITAL
things commonly served. In this way food can be ap-
portioned to the wards fairly accurately.
Nurses, student dietitians, and every one connected
with the serving should know how many servings can be
cut from a pound of butter, or a loaf of bread, how
many glasses of milk can be served from a quart and
how many servings of sugar in a pound. The govern-
ment is now giving this information in bulletin form.
Provision may be made for any who might wish a
second serving, this allowance to be governed by the size
of the ward and whether it is medical or surgical, male
or female, and so on. Provision should also be made
for the admission of one or two patients. If an un-
usually large number of new patients are admitted or
discharged from any part of the house after the re-
port is sent in, the nurse in charge should notify the
kitchen in time to permit of necessary changes.
This may sound like a great deal of detail which is
more trouble than it is worth. Not at all. Provided
he has the utensils, it is much easier for a cook to serve
systematically than in a haphazard manner; and it is much
easier for the one doing the serving to know these de-
tails than it is for her to guess at them and have to handle
the food a second time in order to correct mistakes.
In the larger hospitals with which I have been most
familiar we have had made for our use food containers
which met our needs very well. They are on the prin-
ciple of a hot water bath, consisting of a large outside
container into which fit smaller boxes or containers for
meat, potatoes and other vegetables. Each ward has a
container, the capacity of which corresponds to the size
of the ward. They are made of heavy grade aluminum
with a latticed rack or tray fitted into each of the large
containers, forming a false bottom. Hot water is poured
into this outside container, and the smaller receptacles
containing the food are placed on the rack. A cover
fits the larger or outside container. By this method
the hot water prevents the food from becoming cold dur-
ing transportation, and when it reaches the ward the
container is placed over the gas flame, one flame being
sufficient to keep the whole dinner warm. The water
in the box prevents scorching or drying of the food, so
that the last serving is as hot and in as good condi-
tion as the first, even in wards where forty trays are
served. When the serving on the ward is finished the
cover is placed on the container and the food returns to
the kitchen in the separate receptacles in good condition
and capable of being utilized again.
One person from the diet kitchen is responsible for
the care of this food as it is brought back from the
■wards. This does away with the tendency to have several
dishes containing the same kind of food accumulate in
the ice-box if the supplies come back from different parts
of the house at different times. With these supplies ar-
ranged in an orderly manner in the ice-box, it is a com-
paratively simple matter, in the morning, to see what
is available, decide how it can be used to best advantage,
and instruct the various people in the main kitchen and
diet kitchen as to what they may have — also, it is valuable
training for the nurse or student dietitian to allow her
to look over the' supplies and determine what she can
use and for whom among her special menus each food
is best adapted, and suggest ways of preparing each.
In addition, this system insures a minimum of waste
either in the ward serving rooms or in the kitchen. How-
ever, in order to prevent waste or extravagance one thing
is absolutely necessary — a proper interest in the work
of the department. Without this, any system will fail
to get the best results.
The nurses and others working in the diet kitchen
should be given an insight into the work of the main
kitchen and should be taught the principles of the things
they cannot do in the diet kitchen. They should also
be instructed in regard to steam cooking of vegetables
and cereals, roasting of meat, uses of equipment, or
labor-saving devices, as well as how to judge qualities,
especially fish, poultry and meat. They should be told
something of costs, and of the work and care necessary
to the feeding of large numbers of people. This infor-
mation will give them a different attitude toward the
department, make them more careful when they do the
serving on the wards, and less critical of their own
food. A nurse who does not have a different viewpoint
after such a diet kitchen training is an exception. The
cooks should realize that the nurses are there to learn
and that it is their privilege to help teach them. They
will be interested in the dainty things sent out from
the diet kitchen, and it is time well spent to tell them
something of the diseases or the patients who are being
treated by special diet. When they realize that an ap-
parently small matter may cause serious results in diseases
of metabolism they have greater respect for their work
and take pride in doing it well. This spirit in the de-
partment is worth more than any other one thing, and
it is one which is very difficult to obtain without an
intelligent, tactful leadership.
This harmonious working together, as of one unit,
should not be confined to the kitchens, however, but
should be carried to every serving room in the house.
Unless one has been brought face to face with it, one
would scarcely believe that there could be so much ex-
travagance due to seemingly insignificant things as may
be found in the serving rooms of our hospitals. It is
quite the customary thing for the nurse in charge of
a ward to order a quart of milk, a dozen eggs, or a few
oi'anges and lemons, more than she needs, in order to
have them for emergencies. This may be permissible
so long as she is thoroughly familiar with what she
needs. Frequently, however, she is not familiar with
them, and she thinks this is too small a matter on
which to spend any time. Milk, the most generally used
food material in the hospital, is in too many instances
used with criminal extravagance. This is not intentional
on the part of any one, but, since no one takes any
special interest in the quantity used or in checking it
up, the practice continues.
To one who has lived in a hospital and is accustomed to
seeing everything in large quantities, these small amounts
seem too trivial to require any attention; but when these
small amounts are multiplied by eight or ten, or whatever
number of service rooms the hospital contains, and then
again by seven, the number of days in the week, the
amount is no longer trivial. Very few of the people who
are being served in our hospitals and other institutions
with no care or effort on their part have any realization of
the things to be considered or the real work required
in the preparation and service of their meals. It is
a trait of human nature to have no interest in a thing
about which we have no knowledge, and this probably
accounts for the indifference shown by so many even in
positions of authority.
At this time, when it would seem that every one
would feel a personal sense of responsibility, we find the
service in many places changed only in so far as market
conditions have compelled them to change, and any effort
at conservation in the kitchen is met with much objec-
tion in the dining room.
On the other hand, the dietitian has an equally great
THE MODERN HOSPITAL
397
obligation to the other departments in the hospital. The
nurses and physicians have their own troubles and should
not have to contend with irregularities from the kitchen
and storeroom. It is their due that they have supplies
sufficient for their needs and that their supplies reach
them in good condition; also that special orders and
special diets receive special attention. Mention has been
made before of the importance of good food and good
service to both the sick and the well in the hospital.
There must be a desire for mutual helpfulness. It
is small incentive to any department to develop a
systematic or efficient method of procedure, only to have
the results counteracted in some other part of the or-
ganization. Now, as never before, is there great need
of close cooperation. So many of our nurses and physi-
cians are giving their services elsewhere that those who
remain in the hospital are called upon to do the work
previously done by two or more people.
The dietitian has a great opportunity to enlarge her
sphere of usefulness. She may assume greater responsi-
bilities in the service on the wards, thereby relieving the
nurse and physician of much of the care of the patients
receiving dietetic treatment. She can extend this service
to the dispensary patients as well as the ward patients.
But her difficulties due to market and labor conditions
should be recognized and proper consideration showm her
department. Special orders should be issued only when
unavoidable, and care should be taken with supplies
and extras of all kinds to prevent accidents or make it
necessary to duplicate supplies or do extra work of any
kind. While this other work cannot go on if details
are neglected, it is perfectly obvious that the less time
devoted to routine work, the more time wdll be left for
the larger service.
This is where many hospitals make a mistake. They
do not get the greatest possible value from their dietitian,
because they have the wrong conception of her value.
Dietotherapy has too prominent a place in the medical
world today to permit of its being neglected. It is the
dietitian's province to work with the physician in this
branch of medical treatment, providing the proper foods
and seeing that they are properly prepared and served,
instructing the nurses in this subject in both theory and
practice. And here again results depend upon coopera-
tion; nurses cannot be given this instruction if their
diet kitchen training is put in at any period in their
hospital training, or if it is given for a certain length
of time when they can most conveniently be spared from
ather parts of the house. A nurse cannot be taught
dietetics as soon as she enters the school; neither can
she be taught this subject in twelve lectures, or in four
weeks' service in the diet kitchen early in her training.
It is well for her to have some instruction early in her
training which will fit her for the work required in
the hospitals, but she has not the foundation, either in
knowledge or experience in nursing, to understand the
principles or the importance of dietetics until later in
her course; and she should be given at least a part
of this instruction with the more advanced work of the
school.
You will note that a rather big piece of work has
been outlined for the dietitian — supervision of the en-
tire dietary department, including ward service; a more
thorough course of instruction for nurses; and a very
close contact with the medical men, not only with the
patients in the hospital but also in the dispensary. This
means she must be an executive, an instructor, and one
of the hospital staff. Is any one else in the institution
given so many responsibilities of so diverse a nature,
and still expected to give some attention to the details
of the department ? Of course, she cannot assume all
of this without some assistance.
But, you will say, our dietitian is not doing this kind
of work. She is not competent to do it (and I well know
some dietitians do not care for this larger service) . To
both statements let me ask "why not?"
Are you making it worth while for a competent woman
to take charge of your dietary department? How many
of you are giving your dietitian any authority to develop
her department or to carry out her plans? Or, are you
giving her only the same authority and position that
is given to a head nurse who has charge of but one
ward and who is never called upon to do any teaching
or other work outside of her individual ward, except
perhaps in an emergency? This is very apt to be the
status of the dietitian. She is asked to live in a room
similar to that of the pupil nurse, with possibly another
chair in her room or the privilege of an extra towel
occasionally, but with no thought of comfort to counter-
act the influence of the noisy, hot place in which she
must spend her working hours — a place in which you
or the superintendent of the training school do not care
to stay even long enough to discuss with her a question
of interest to the department, preferring to call her to
the comfortable office provided for you.
In spite of the fact that her work requires definite
thought and planning, both for the department and for
class work, the need for keeping records, accounts, per
capita costs, etc., much communication with others
throughout the house, and still others who are not in
the house, either by personal interview or telephone,
very few hospitals furnish their dietitians with office
facilities.
Can you expect a woman who has fitted herself to
do real dietetic work, or to become a good executive or
to do both — to assume so great an obligation under such
circumstances? She knows she cannot get the results
she would wish, nor can she accomplish her best work
in the face of such handicaps, and she has no desire
to attempt it. A few hospitals have come to a realiza-
tion of this and have given their dietitians a recognition
which means more than anj-thing else in the success
of developing a well organized department; and there
were a few women ready to do it.
If you are familiar with the achievements of women
who are managing the lunch rooms and dining halls of
some of our larger educational institutions and com-
mercial plants you cannot fail to see how the same
principle applies to hospitals.
These educational institutions feed only people who
are well and have normal appetites, yet they have
recognized the value of dietitians. How much greater
should not the value of dietitian service be to hospitals!
This field of opportunity has been opened so recently
that it is not always possible for a hospital to find the
woman they want at once, but there is almost always
some one ready and anxious to do the kind of thing
which is worth while. Frequently, however, it is more
desirable that this type of woman be developed. The
hospitals ai-e helping very much in this respect when
they offer a course of training to women who have had
college courses in foods and nutrition. These courses
vary in length from three to six months, and one hos-
pital, at ieast, is known to offer a nine months' course,
which is in the nature of post graduate work and has
proved a good thing for all parties concerned.
398
THE MODERN HOSPITAL
It is worth a great deal to the hospital to have one
with a thorough knowledge of domestic science to assist
in the instruction and supervision of the work with the
nurses in the diet kitchen, as well as in the prepara-
tion and serving of special diets. It makes possible
the doing of more work and assures greater accuracy
in all that is done. The dietitian is relieved of much
detail if she has some one who can carry out orders
intelligently and upon whom she can place greater re-
sponsibility than can be given to the nurse, whose time
in the department is too short for her to get more
than the general principles of dietetics. The experience
is of great value to the one taking the training. It gives
her an insight into hospital technique and affords her
an opportunity to learn much of diet in disease that
can be learned in no school or college. Later it is a
benefit to the hospital employing the woman who has
had this training.
It is to be regretted that there has been some objec-
tion to offering this training — both by hospitals, and
dietitians. The objection of the dietitians has been that
colleges send out graduates with such inadequate prepara-
tion that they are more of a hindrance than a help in
the department. That is undoubtedly true in some, but
not in all cases. When she finds she has accepted for
this training a woman who is not fitted for hospital
work, it is the dietitian's duty to the student, to the
hospital and to herself not to allow her to finish the
course. With so many desirable candidates as there
are now, it is entirely unnecessary to consider one not
adapted to this work; and there are so many fields of
service that one should have no difficulty in finding a
work for which she is adapted.
The objection of the hospitals to the student dietitian
is that she may usurp some of the privileges of the
nurse — that the pupil nurse is not permitted to do some
of the things in her diet kitchen training she should do
because these tasks are performed by the student dieti-
tian instead. Such a situation need not and should not
exist. The presence of the student dietitian ought to
insure better and more complete instruction for the pupil
nurse.
The student dietitian is usually a college graduate
whose need is a training in application of her knowledge
to diet in disease, and for administrative work, which
she gets in her practice with the pupil nurse. The need
of the pupil nurse is for the practical knowledge of
food, its composition, preparation, and value in dieto-
therapy. The lines of training are so different for the
two that there is little probability that one will detract
from the other. In view of the value to be derived from
such a course, it is to be desired that all hospitals hav-
ing a well established medical and dietary department
will formulate a course which would attract well-equipped
graduates of domestic science.
Since the food situation has become so intense many
hospitals which have given the matter no attention in
the past are feeling the need of a trained woman in
their kitchen. Let us hope that, out of the chaos and
discouraging experiences of this critical time, a better
and fuller relationship between the dietary department
and other departments of the hospital is going to de-
velop.
The American Red Cross is one opportunity which of-
fers you many ways of "doing your bit." The best way
to help your country is to give it part or all of your time
and enthusiasm, but, if you can't do that, save every scrap
of everything to be made over by the government.
Health Insurance and the Hospitals
Bv JOHN A. LAPP. Director of Investigations ot the Ohio Health
and Old Age Insurance Commission
What I have to say is not a statement of the known
facts about health insurance nor an argument for its
adoption as a social policy in this country. It is rather an
attempt to describe the relation of the hospitals to such
insurance if the same should be adopted by any state.
We have been attempting in seven different states to deter-
mine whether state-wide compulsory health insurance
should be favored for legislative action. These states are
using for this purpose the time-honored method, a spe-
cial commission of inquiry. Three state commissions re-
ported in the last two years in favor of health insurance
and one declared against it. No legislation has yet been
enacted in this country upon the subject, but most search-
ing inquiries into its merits by public and private bodies
and by individuals are being made, and in one state. New
York, a comprehensive bill has been introduced with the
powerful backing of the State Federation of Labor. These
facts bring the discussion of health insurance out of the
realm of the academician into the realm of practical poli-
tics. It is time, therefore, for those directly interested to
give it careful consideration.
While upon the general proposition I desire to express
no opinion, I do wish to discuss certain aspects which have
to do with the plans and specifications of the structure.
We do not need to be reminded of the importance of the
working drawing in mechanics, but it appears that in leg-
islation everyone forgets that laws should be built upon
working drawings of carefully prepared plans. We have
too much "rule-of-thumb" legislation, too much "hand-
me-down" thinking on law making. The contests of leg-
islatures are pitched on the idea that somehow, some way,
the legal structure will rise in true majesty without go-
ing to the trouble of working out the details and placing
working drawings in the hands of the builders. It is not
to be wondered at that there are some monstrosities, not
strange that there are laws without roofs, chimneys, ven-
tilation or light.
We propose to determine whether health insurance is
desirable as a state policy, but in doing so we intend to
have before us some tentative drawings of its scope and
application. When we know what the plans contemplate
we shall know better how to decide the main issue.
Let us see what social health insurance calls for as ir-
reducible benefits. At the very lowest we have two which
must be provided if the plan is to be anything more than
a fifth wheel in our system of charity relief. They are
cash benefits, and adequate medical and hospital care.
Other benefits might be sacrificed. But if either of these
is left out, the structure falls.
Speaking of compensation for accidents, the Washing-
ton Supreme Court recently said, "Compensation means
more than the mere cash payment to an individual. Com-
pensation to employees for injuries incurred by them may
fairly be said to mean not only a money payment for the
various elements of loss which may be the direct result of
this injury. It includes, for example, the obligation to
provide medical and surgical treatment, an obligation
which does not necessarily involve payment in cash to the
employee himself."
Insurance is a coverage of risk of loss, not money loss
merely, but all loss. The loss to an individual by accident
and disease consists of three parts — his wages, the cost of
medical treatment, and the loss of working power. The
relative importance of these depends upon the circum-
stances of the case, but in the majority of serious cases
involving hospital treatment the loss of wages is the
THE MODERN HOSPITAL
399
minor item— that is, if the doctor and hospital bills are
paid. But, aside from the relative magnitude of any one
of these losses, there is such a direct connection between
cash benefits and medical and hospital benefits as to make
imperative, in any plan, ample provisions for both. Work-
ing men with families cannot very well take time to re-
ceive necessary medical treatment without cash benefits to
tide them over, and the ambitious will not remain long
enough under treatment to be permanently restored un-
less their families are sufficiently provided for support as
a matter of right instead of charity. But mere cash bene-
fits will not buy family support and medical care also.
The primary object is to put the man back on his feet
completely restored to working power as quickly as pos-
sible. He must have medical or surgical treatment. He
cannot buy it with his cash benefits, which are needed for
family support. If he goes without the necessary treat-
ment, he remains on the insurance fund unduly long and
perhaps becomes incurable or dies.
When workmen's compensation was introduced, only one
form of benefit was prominently in the minds of law-
makers, the cash payment measured roughly by the loss.
As an afterthought, some states gave a little medical care.
A few states gave slightly more than a "little" care. Of
the thirty-eight states and three territories which now^
have workmen's compensation laws, four states give no
medical benefits whatever; nine states give medical care
for fourteen days; three states give medical care for three
weeks; six states give medical aid for four weeks or for
thirty days; five states fix no time limit but fix a money
limit. Connecticut, California, Idaho, Washington and
Ohio give unlimited medical benefits, but in Ohio expendi-
tures over $200 must be approved in advance, and in
Washington half is to be paid by the worker. Fifteen
states which have a time limit have also a money limit,
which ranges from $2.5 to $200.
The most liberal provision is that found in the United
States Compensation Law, which provides for i-easonable
medical, surgical and hospital services and supplies, with-
out limit as to time or amount, and, if necessary, trans-
portation of injured employee to the place where he can
be properly treated. Aside from those which grant no
medical benefit at all, the most illiberal is that of Penn-
sylvania, which provides for reasonable surgical, medical
and hospital expenses for fourteen days, but not to ex-
ceed $25 unless a major surgical operation is necessary,
when the amount is limited to $75. Even a layman can
smile broadly at that provision.
This review of eyperience under workmen's compensa-
tion acts is important in the consideration of medical and
hospital benefits under health insurance. The same prin-
ciples apply. The object under health insurance as well
as under compensation insurance is to rehabilitate the
man. We cannot do less in fairness to the disabled per-
sons and to society. Unfortunately, in the past, man-
power has not been properly appreciated. Human sal-
vage has not been foremost. If men were thrown on the
scrap heap, there were generally other men to take their
places. The supply seemed inexhaustible. Humanity was
playing the role of Rip Van Winkle. Now, however, things
are changed. Man-power is important, and humanity is
awake.
Whatever may have been in the minds of the advocates
of compensation and health insurance in the past relating
to rehabilitation must now be discarded in the light of
economic and human facts. Workmen's compensation in-
surance must be directed to the prevention of accidents
and the restoration of men physically and vocationally.
We would be fatuous, indeed, not to heed the lesson and
make prevention and rehabilitation the cornerstone of
the health insurance plan. We do not know in any state
how many men have been deprived of earning capacity by
accident. We do not know how many men who are now
receiving compensation could be restored partially or com-
pletely to working power. And we know practically noth-
ing at all about the extent of the problem of removing
handicaps caused by sickness which impair working pow-
er. We are beginning to realize that we ought to know
about these things under compensation. We shall prob-
ably not do much about the handicaps from sickness un-
til the burden is definitely placed and a proper restoration
plan has been worked out and applied.
The fact is that nearly everyone was thinking of casn
benefits only when the workmen's compensation acts were
passed. Medical and hospital care seems to have come
merely by chance. Certainly the doctors and the hospitals
were not on the job. Correction of the defect is proceed-
ing, and we may expect many states to get the proper
perspective at an early date. Already, Ohio has removed
the $200 limit fixed in 1913; California has removed her
time limit; Washington, which at first gave no medical
benefits, now gives unlimited benefits, though the worker
must pay half of it — a quite indefensible provision from
the standpoint of social insurance unless the worker is in-
sured for his half of the expense. New laws generally are
more liberal than the first ones passed.
It was natural that cash benefits should have over-
shadowed all else because everyone thought in terms of
damage suits, which were always for a fixed sum in cash,
supposed to cover all loss. The transition to the new era
of insurance when the workers would be protected against
all minor, as well as major, losses, and those losses were
to be paid automatically without the aid of a legal bludg-
geon, was not fully comprehended, and the broad princi-
ples of rehabilitation were not applied.
It is important that, if we are to have health insurance
on the same model, this mistake shall not be repeated.
The restoration of the physical man to working power
must be the primary object in this, as it should have been
in the compensation acts. Cash benefits are merely the
props of this process. If we are to restore a man we
must keep him and his family from dependency. We do
infinite harm at present by forcing a sick man to allow
his family to eat the bitter bread of charity. It is not
humiliating to most people to receive medical care from
the public or charitable hospital, but to receive money
from charity for things for his family to eat saps out all
that is best in man.
So I say, cash benefits are necessary to the salvaging of
sick and injured men to keep them from dependency, to
enable them to stay long enough under medical treatment
to effect a cure, and to give that contentment of mind
which is necessary to recovery. The real object of it all
is, however, the rehabilitation of the man in his working
power so far as possible.
It is true that, in any case, a man might provide by sav-
ing for a rainy day, provided that rainy day did not de-
velop into a rainy season. I shall not discuss that aspect
of the case except to raise the question whether the aver-
age working man under present wages and costs of living
can hope to provide for many rainy days, much less a
rainy season, and further to suggest that "the cold facts do
not warrant any particular optimism in that respect, when
in good times more than 10 per cent of the people are in
economic Tiistress, to say nothing of the fact that people
generally are not at present prepared to withstand with-
out distress an ordinary sickness of the breadwinner.
Coming now to the question of the relation of the hos-
400
THE MODERN HOSPITAL
pital to this whole matter: Clearly, the hospital must be
the center of the rehabilitation movement. It has not
been sufficiently so under workmen's compensation, partly
because the hospitals did not see clearly the relationship
between them and the new order, and partly because too
many people thought in terms of charity. So it came
about that hospitals were asked to perform their services
at less than the actual cost to them. The hospitals were
thus expected to bear part of the burden which, under the
law, belonged to the employers. The reason for this, no-
body ever explained. It just happened that way. Com-
pensation commissions have been known to cut the bills of
the hospitals arbitrarily without regard to hospital costs.
They have been doing this by a process which has been
aptly called a "pencilanimous process." Perhaps in some
instances hospitals sought to make the employer or the
insurance fund or company pay for a part of their own
charity work by excessive claims. If so, it is no more de-
fensible than that the hospitals should assume the burden
of the employers or insurance company by furnishing
services at less than cost. Regardless of the practice, the
principle is clear, that under workmen's compensation and
under health insurance the hospitals should receive enough
to cover their total cost. They generally ask no more.
They cannot be expected to accept less. They are unfair
to a great purpose which they represent if they take less,
for it is perfectly plain that the public, which contributes
either by taxes, donations or benefactions, to the support
of charitable institutions, either public or private, is en-
titled to see that the money which they spend is not used
to assume the legitimate burdens of the insurance system,
whether it be compensation insurance or health insurance.
Of the details of cost keeping and the division of the
payments among doctors, nurses, and the hospitals, I de-
sire to say nothing except to lay down the broad principle
that no one should be expected to perform any service for
the insured men without i-easonable compensation. Let us
once for all get it clear that, so far as the insured group
is concerned, charity in the old sense of the term is no
longer necessary.
The American Hospital Association has defined, for pur-
poses of accounting, three classes of patients: free pa-
tients, part pay patients, and pay patients. The first are
unable to pay for any part of their treatment and conse-
quently the burden falls upon the hospital, to be paid
out of public support or private benevolence. The "part
pay patients" are able to pay a portion of the cost of
treatment, and the balance is supplied by the hospital, as
in the case of free patients. The "pay patients" pay at
least the cost of their care, and from some a profit is ob-
tained, which helps to supply the deficiency in the other
classes.
Under health insurance a great part of the free pa-
tients, and most of the "part pay patients," become "full
pay patients." The insurance fund will meet the bills for
the cost of their care. The hospitals can still properly
give charity to those not protected by insurance, and it
can still sell its services to others at its own prices; but it
cannot justly make the insurance fund pay a profit in or-
der to take care of the poor, nor can it be permitted to
accept less than cost and thus pass an illegitimate burden
to the insured public.
It may be difficult for some who have grown up with
the idea of hospital service for the poor to adjust their
thinking to the new conditions. The humanitarian im-
pulse will still find a field for action among the very poor
who are below the insurance line. It will find expression
also in enlarged service for those more fortunate ones who
are to care for themselves under health insurance. In-
stead of furnishing the minimum which the poor require,
it will seek to give the maximum which the medical bene-
fits of insurance will buy. A great expansion of research
will be possible. Scientific diagnosis, adequate clinical
facilities, and precise record will enlarge our intelligence
of disease prevention.
Accurate statistics of disease based upon complete diag-
nosis will lead us to the lair of many diseases. Statistics
may sometimes be perverted, but, if we honestly follow
where mortality and morbidity statistics lead, we shall
find the culprit. With the unerring certainty of the blood
hound following a scent, we shall be able to trace the
courses and mediums of transmission of many dreaded
diseases. We should develop more adequate statistical
systems without health insurance, but they cannot in fact
become precise without the aid of more comprehensive
facilities of diagnosis and adequate provision for observa-
tion during care. When the aim is primarily to give em-
ergency relief to the needy, this cannot be done. In such
cases, hospitals and doctors can afford to give only the
minimum required by humanity. Where it becomes worth
while in dollars and cents to the community, the employees,
and employers to give complete restorative treatment, the
situation will be radically changed. We have a chance for
the first time to put the vital statistician at work on a
real job and to make his statistics work for the better-
ment of mankind.
If there should be a general development of social
health insurance, we must expect to see a great enlarge-
ment of hospital facilities — and especially if we recognize,
as we must, that it is good business to provide adequate
medical and hospital care in order to keep people off the
insurance fund and to restore them to work just as quick-
ly as possible. The most progressive enterprises under
compensation insurance recognized the business value of
this idea almost at once, and there are hundreds of indus-
trial physicians and surgeons whose job it is, principally,
to prevent injuries from developing into partial or com-
plete disablement and to bring the best care possible for
the treatment of injured men, both for the sake of the
man himself and for the cutting -down of insurance costs.
Compensation commissions are recognizing the principle,
and each year sees an expansion of the law and a liberal-
izing of its interpretation. The business and humanitarian
principles so clearly developing out of the experience of
the last ten years ought to be the foundation of any plan
of social health insurance.
Lastly, there is the problem of malingering to be un-
derstood and dealt with by the hospitals and physicians.
We know very little about malingering at present. The
problem has been little studied in this country. While we
have had many instances under personal accident and em-
ployers liability cases, it is only since workmen's com-
pensation became general that the problem has become a
social one. Health insurance will add another incentive to
malingering, although it is generally conceded that there
is far less of it proportionately growing out of disease
than accident.
Malingering results from a desire to escape work, to ex-
cite sympathy or to reap pecuniary advantages. It should
be carefully differentiated from disease due to mental or
nervous derangement. It is the problem of hospitals and
doctors to determine whether it is fraud or disease and to
counteract the fraud and understand the character of the
disease. The war is teaching many lessons. We are
learning that much which might have been called maling-
ering is not a conscious simulating of disablement. Sir
John Collie, the leading English authority on the subject,
recently said in the Dublin Review, "As it was knovni
THE MODERN HOSPITAL
401
that it was possible for a person to be really ill from
merely witnessing an accident although no physical in-
jury was sustained, and that a serious derangement of the
nervous system, involving marked loss of function, could
result from emotional causes alone, the soldier with no
apparent wound or injury to show to justify his condition
became the object of greater solicitude than otherwise
might have been the case."
Malingering is not a new problem to be created by
health insurance, but health insurance administration
should profit by the experience concerning it. The extent
of malingering is exaggerated for political effect. At the
worst, only a fraction of one per cent are fraudulent mal-
ingers. In two thousand cases of suspected malingers
sent for special examination in England Sir John Collie
found 25 percent able to go to work, which would have
been an insignificant percentage of all the injured work-
men from whom the two thousand cases were selected.
Yet the situation should be met by a new type of diagno-
sis. Even a slight amount of malingering has a bad ef-
fect upon the morale of the insured people, and is de-
structive to the few who fraudulently practice it. Hospi-
tals have had much experience in the prevention of hos-
pitalization among patients. That experience will be val-
uable in handling the same problem under health insur-
ance.
To sum up, this paper argues for adequate medical and
hospital treatment for all cases under workmen's com-
pensation and in any scheme of health insurance which
may be set up; it emphasizes rehabilitation as the ulti-
mate goal; it recognizes the strategic position of the hos-
pitals in the administration of broadly conceived health in-
surance; it demands that all idea of charity shall be re-
moved and that hospitals be neither required nor per-
mitted to furnish service for less than its total cost; it
urges an accurate system of records and statistics for
tracing the incidence of disease and the fullest research
and investigation of prevention and correction of disease;
and it suggests a thorough study of the problem of
malingering.
New Jersey Hospitals Organize
During the recent Atlantic City meeting of the Ameri-
can Hospital Association, representatives of New Jersey
hospitals present formed a tentative organization. Mr.
Cornelius S. Loder was elected chairman, Mr. Gallagher,
supei-intendent Jersey City Hospital, chairman of the com-
mittee on constitution and by-laws, and Miss Eugenia D
■ Ayers, superintendent of Elizabeth General Hospital,
chairman of the program committee. The association is
to meet in November, in Trenton, for the purpose of per-
fecting an organization on the general plan of the nation-
al hospital association.
Influenza Causes Postponement of Convention of Ameri-
can Public Health Association
The influenza epidemic caused the postponement to
December 9-12 of the annual meeting of the American
Public Health Association, which was to have been held
October 14-17. A good attendance was assured from the
upper Mississippi Valley where influenza had not yet be-
come generally epidemic. However, at the urgent request
of the Surgeon General of the U. S. Public Health Ser-
vice and of many Eastern speakers and delegates, the
later date was set, it being judged unwise to take sani-
tarians from their posts at this time. Further announce-
ment will be issued by the association at Boston, and will
be published in the American Journal of Public Health.
OCCUPATIONAL THERAPY,
VOCATIONAL RE-EDUCATION
AND
INDUSTRIAL REHABILITATION
"^^
nducted by DOUGLAS C. McMURTRIE, Director Red Cross Institute foi
Crippled and Disabled Men and ELIZABETH G. UPHAM, Advisor
in Occupational Therapy, Milwaukee-Downer CoUeSe.
OCCUPATIONAL THERAPY IN CANADIAN WAR
HOSPITALS
By NORMAN L.
BURNETTE.
ilided Soldiers-
Inspector of Convalescent Schools,
Canada.
Work, considered from the viewpoint of therapeutics
and not vocation, is a comparatively new thing in the
treatment of the Canadian wounded.
The reason is not far to seek. The immensity of Can-
ada's war contribution and the obvious effect on her indus-
trial life made it imperative that every possible worker
Fig. 1. A reconstructit
aide giving
maimed soldii
should be saved to the state in some shape or form. In
the beginning, our anxiety to start the education or re-
training of the returned men at the earliest possible mo-
ment blinded us to certain of the psychological factors in
sickness. These factors are now so well understood that
it is not necessary to go into them here. It is sufficient
to state that men who have been exposed to the diverse
influences of army life, followed by severe injuries and
long periods of enforced idleness in hospitals, are neither
physically nor mentally fit to stand the strain of industrial
life, nor to take intensive training as a preliminary thereto.
Both mind and body have to be brought back gradually to
a state of normal activity. So, out of the result of our
first experiment in vocational training, was born "occu-
pational therapy."
Unlike the States, Canada had no trained workers and
no experience covering a decade of work among the in-
402
THE MODERN HOSPITAL
sane. In one respect, this was an advantage. It forced
us to approach a new problem with open minds uncolored
by years of labor among asylum patients. It can not be
stated too often or too emphatically that the returned sol-
dier is neither a lunatic nor an old woman who wants to
spend his declining years doing tatting or embroidering
sofa cushions.
Having realized the part that occupational therapy had
to play in the process of reconstruction, the first thing to
Fig. 2. Basket-making on the lawn.
do was to provide a corps of trained workers. The De-
partment of Soldiers' Civil Re-Establishment decided on a
central training school, and Toronto was chosen as the
place of training. The great University of Toronto,
which, in common with the other Canadian universities,
had thrown itself whole-heartedly into all forms of war
work, houses the school in one of the fine buildings of
the department of engineering and applied science, and
the school is governed by a committee drawn from the
faculty of the same department.
Students are sent here from all over the Dominion and,
before entering, sign a contract to serve for a full year
after being accepted as "aides," in any part of the coun-
try, and in any type of hospital required. Before being
taken on the establishment as an "aide," the student is
required to do two months' probation work in a hospital.
This is in addition to a period of part time practice work
which the student gets in the Toronto hospitals during
her university work. The Toronto hospitals are considered
a training depot, through which all of the students will
pass. The department pays a subsistence allowance of
§4.5 a month during training, and the probationers' train-
ing is very strict. The weeding-out process goes on all
through the course without fear or favor.
Girls taken on the establishment are outfitted by the
department with a uniform consisting of a green tunic
and skirt with brown belt, and white veil, collar and cuffs.
The summer hat is a white panama with broad green rib-
bon. The overcoat is a double-breasted military coat of
dark green, with a belt and shoulder straps. The buttons
on tunic and overcoat are khaki leather-covered. Proba-
tioners wear all white.
The school gives instruction in the crafts, and a staff
of lecturers, which includes army doctors as well as other
specialists, prepare the girls for a proper understanding
of the varied problems which confront them.
Lectures by the matrons and officers commanding the
Toronto hospitals are also given the girls in training, and
the same valuable method of continuing their education is
used when the "aides" go to an outside hospital.
It goes without saying that a high standard of entrance
has to be maintained. The school could never undertake
to turn beginners into skilled craftsmen in a short time.
Fortunately, some of the much-sneered-at fads and frills
of our latter day education are coming home to roost, and
a knowledge of design and one or more of the arts seems
to be widespread.
Young as the work is, it is already an assured success.
It has lighted up the sad, dark places in many a hospital
and sanatorium. It has turned a home for incurables
into a place of contentment, where one may hear laughter
and witness the God-given miracle of pain forgotten
through the joy of work. It has opened up a whole new
vista of possibilities in the treatment of shock cases, and
is vieing with mechanotherapy in the bringing about of
cures to crippled hands and stiff arms. Like many an-
other war measure, it has come to stay, and it is to be
hoped that what is being done in military hospitals will
still be carried on in civil hospitals when this war is but
a memory.
AN EXPERIMENTAL EMPLOYMENT BUREAU FOR
CRIPPLES
Work Gives the Afflicted a New Lease on Life — Changed
Attitude on the Part of Employers
By ELEANOR ABLER
Ten years ago a young cowboy came home from a
Western ranch to spend Christmas with his family in
New Jersey. When he started back for the West two
weeks later, he saw his train just moving out, and, run-
ning for the steps, slipped, missed them, and fell under
the wheels. Two days afterward he came back to con-
sciousness in a hospital, to find both his legs gone at the
knees. One careless moment had put him into the great
army of the ci'ippled.
The hospital did what it could before sending him back
to his family with wooden legs and a pair of crutches.
.4nd there in a small room he sat for two idle and useless
years — a brave but derelict boy. After a while his
family proved too poor to support him and shifted him
to a brother in Bi'ooklyn. The brother in turn, tired of
his care, gave him a small sum of money and told him
"to get out on his own." But nobody wo'^ld give work
to a cripple. He lived in a furnished room, hunting
daily for any kind of a job; then he drifted to a lodging
house; and after despair and hunger had taken the fight
out of him a policeman found him on the streets, arrested
him as a vagrant, and sent him over to the Old Men's
Home on Blackwell's Island.
And among the old men he might have stayed on for,
perhaps, the rest of his life, sitting next to a cot reading
a paper or staring at the wall — derelict indeed. But one
day a happy chance sent two women on a visit through
the wai-d, and they were so haunted afterward by the
dreary monotony they had seen that they decided to
start a course of basket-making for the inmates. When
the teacher came she was horrified to find a bright boy
of twenty-two among the old men. She got in touch,
as soon as possible, with cripple agencies in New York —
agencies which had long felt the need of giving crippled
boys some kind of trade training, and had recently opened
an experimental class in jewelry and metal work. The
young cripple was taken off "the Island.." lodged in a
cheap boarding house and put in this class. Four months
later he finished his training and secured a job. And from
that day on he has earned his keep back in the ranks of
normal human beings. He turns up once in a while to
have "a leg repaired," but always says he can stump
his two miles a day on his wooden feet as well as any.
He is a thoroughly happy and contented man, one of the
pioneers who has proved that a cripple can "come back,"
THE MODERN HOSPITAL
403
and that, with training and careful placement, the disabled
man or woman can do away with disablement.
It may seem a far ci-y from the story of this cowboy
to the needs of the crippled soldiers and sailors. But,
at the time, the cripple boy blazed a trail in the United
States. The contrast of what his life might have been,
lingering on among the wrecks of old men, and what it
became, back among the young and sanguine, was a
dramatic revelation of wasted possibilities. It proved in
a graphic way that a man who has lost his legs can be
worth his salt industrially if he is given a chance to get
some trade skill in a suitable trade. And it made it in-
increasingly intolerable that other cripples should not have
the same chance. The long lines of disabled men and
women at the different agencies — all eager for work, any
kind of it, and all hopeless of getting it — seemed more and
more a tragical waste of good material. The problem,
brought home in this way, finally became crystallized by
many accounts of other cases; a movement was put on
foot to provide such handicapped with adequate jobs, and,
despite misgivings, a small experiment was started, an
employment bureau for cripples.' At the time many
doubted its practicability; cripples were still classed with
dependents and beggars; and an appeal for funds, made
to a ioomful of men and women who had all been strong
supporters of cripple work, met with refusal on the
ground that the scheme was impossible. Nevertheless,
the bureau was established, and succeeded in proving in
a small way what it had hoped to prove, namely, that,
with training and intelligent effort at placement, the
lai'ge majority of cripples can support themselves.
Since the war has brought its quota of wounded, crip-
ples have been pouring out of the hospitals abroad and in
Canada, and this statement is being much more widely
demonstrated, although, in these cases, it applies
largely to the class of maimed aiid not of diseased
cripples. Meanwhile, as employment bureaus for crip-
ples are springing up in various cities in the United
States, a study of this small experiment may prove
helpful toward their work of refitting the disabled man,
soldier and civilian. The widespread publicity of the
new movement for war cripples is making familiar what
two years ago seemed incredible, and it is hard to realize
now that in May of 1916 the idea of getting cripples
actual employment seemed to many people a visionary
undertaking.
There had been one or two attempts before this to
establish such an employment bureau, but they had not
been permanent. The Charity Organization Society of
. New York ran an employment agency for the handicapped
for five years, in connection with its general employment
work. The society abandoned this work on the ground
that there were increasingly few men applicants, and
that it had become largely a domestic employment agency
for women. Dr. Charles Jaeger conducted such a bureau
in connection with his Hospital of Hope and Trade Train-
ing School for Cripples and gave it up when the hospital
was discontinued. Dr. Richard Cabot and the Kings
Chapel Committee had recently established an employ-
ment bureau for the handicapped in the Massachusetts
General Hospital of Boston, but were intending to con-
duct it on a smaller and more intensive scale than seemed
feasible in New York. So there was little precedent
to look for at the start.
The radical difference between this bureau and its
predecessors lay in its strict purpose to be a business
enterprise and not a charity. The cripple and the em-
of Associations for Cripples and
ployer were to be brought together, but the needs of the
two were to be taken into equal consideration. Cripples
who would not deliver a fair day's work would not be
accepted as applicants, but referred to hospitals, old
men's shops, or relief societies. The employer was to get
a capable worker for the job he offered. It was keenly
felt that any other policy would react — in fact, had re-
acted— on the cripple, so that his condition became in the
end worse than before. The employer, who, having been
touched on the score of charity to give a cripple work,
found his business muddled, was increasingly hostile
afterwards toward "crippled" labor. On the other hand,
the applicants were not to feel that they were receivmg
charity, thei'eby frightening off the more self-respecting
and better-class workers. As a result of this policy, the
bureau was not conducted in connection with any hospital
or charitable organization, but instead, as a department
in a public employment bureau. It was not labeled a
"Cripple Bureau." When an employer telephoned, he was
told that a capable person would be sent him, and it
was then mentioned that the applicant was lame, or a
hunchback, etc. In this way attention was not focused
on the handicap, and rejections on that account hardly
ever occurred. The great advantage the bureau had in
being a department of a public employment bureau, in
addition to its psychological value with employers and
applicants, lay in the State Clearing House for Employ-
ment Agencies. Calls from employers all over the city
were registered every morning; vice vei-sa, applicants
were registered all over the city, and chances for work
were thus greatly multiplied.
Neither New York city nor New Yoi'k state has ever
had a census of its cripples. The bureau was therefore
entirely ignorant of the number it would have to draw
upon. Estimates of various oi'thopedists differed widely,
and, at the beginning, many people prophesied that there
would not be enough cripples to keep the bureau in action.
But the prophets came to no honor, and from the start, a
steady procession of cripples of every kind, men, women,
and children, marched or limped through the rooms.
The records show that they came from every source —
settlements, churches, charity organizations, cripple
agencies, the municipal lodging house, the Red Cross, etc.
A special point was made to become connected with the
"cripple" classes in the public schools, and to put the
children into trade training classes where they could
work up to life-long positions in advantageous trades.
Connection was also made with the disabled men and
women who came from the Workmen's Compensation
Bureau, and with the hospitals, although noticeably few
applicants ever came from the last named quarter. Crip-
ples were sent in from every part of the city, some from
as far as Jamaica and Staten Island. A man who had
only one leg, and who walked on crutches, had been told
about the bureau by a policeman in Central Park.
The crippled man faces a much more serious situation
than the woman. Any woman has ten chances for light
and seated work to one for a man. He must either
possess skill at a trade or the physical strength for heavy,
unskilled work. The crippled man usually has neither.
The fact, however, that men came to the bureau in much
greater numbers than women showed that the problem
was being reached at the right spot.
The task in placing cripples is not confined to securing
immediate work. .A. very necessary branch consists of
resea'i'h work in regard to better industrial opportunities
in general, new trades for which cripples can be
trained, the working conditions and future possibili-
ties of such trades. Opportunities are always coming
404
THE MODERN HOSPITAL
up for better jobs and for new training classes. Such in-
vestigation opens many doors, bridges the gap between
the bureau and employers, and makes a background for
intelligent placement.
A third branch of a successful bureau consists m follow-
up work with the individual person. Modern psycho-
logical methods lay great stress on the study of individual
histor>' and background before placement. Encourage-
ment "and follow-up work during the first month or two
at a job are also practically indispensable. On the other
hand, too much time may be wasted on investigation when
a man needs a position. It is better to place fifty men
fairly well than to make an exhaustive study of two or
three and put them into superlatively suitable positions.
The question is one of proportion and common sense, and
suitable experience must hit upon a golden mean.
Though the cripple can become a normal industrial
unit, he is always subnormal in some particular physical
way. The work found for him must lie outside the zone
of such subnormality, and this zone ought to be clearly
defined by a doctor. In other words, the need of medical
examination for each case is obvious. The bureau made
connections with a clinic to which it was at liberty to send
cases for examination and report, to learn exactly how
many hours and what kind of work each cripple was
capable of, and how much strain he could endure. Many
men wanted to do work for which their strength was not
adequate; others were found to be malingering, perhaps
unconsciously. Unfortunately, the clinic proved to be too
far away, and this opportunity was not utilized as much
as would have been helpful.
The following stories will shed light on the more inti-
mate nature of the problems that had to be met :
A middle-aged negro, who had lost his left leg, told
the bureau that he had been out of work for the last
ten years. He was refused wherever he applied. The
bureau sent him to a firm, which paid him nine dollars a
week to put tinsel on post cards at home, the prejudice
against cripples keeping him out of the factory itself.
After a year and a half of this work, he gave it up be-
cause the jobs were being turned over to girls at reduced
wages. He was next sent to another company, which en-
gaged him at ten dollars a week. But the old firm had
discovered his value, and, not wishing to lose him, asked
him to come back at higher wages and work in the fac-
tory, which he did. Half a year later he was promoted to
foreman, and is still there. A good worker of that type
never needs to be out of a job if only the proper agency
takes an interest in him, finds him what he needs, and
backs him up in getting it.
Another applicant was a boy of seventeen, who had be-
come a hunchback in consequence of a fall. He was very
short and deformed, but had a fine face. He said he was
too old for school and that he was very unhappy there.
Showing some beautiful lettering of his own, which he
had brought wath him, he begged for a job to do art
work. He was placed with a jeweler, who undertook
to teach him the trade.
A middle-aged man, whose leg was partly paralyzed,
had been supporting himself by playing the piano at
cabarets, but, as he said., "was not much at it." He
was sent to a taxicab company, where he was given a
clerical job at fourteen dollars a week, and was told that
he could advance in time to bookkeeper work at thirty-
five dollars. He has written recently that the firm says
he has "made good."
One applicant had been an associate lawyer with the
district attorney before both his hands were cut off in an
accident. The doctor had managed to sew on the right
one with four fingers so that he could use it fairly well.
He was at the time almost entirely wthout funds or
prospects. The bureau placed him where he could do
clerical work at $12.50 per week, and he has been suc-
cessfully employed at the same place ever since. He has
notified "the bureau that he will be glad to give talks for
the Red Cross Institute and "cripple" work any time he
may be needed.
Another applicant, who was deaf and had lost a finger
through infection, had neither -ivork nor home and had
been sleeping on benches in the park. He said he had
been a stage carpenter, but had longed for years to be a
farmer in the country. He was placed in New Jersey,
where he remained from April to September. Then, be-
coming dissatisfied with his treatment, he was sent to
another position in the country as gardener. He has
now been employed there for the past year, sending de-
lighted letters about the work and his room, "which is
so pretty that it ought to be occupied by a young girl,
and not a homely old man like me."
A dwarf with a large head came to the bureau one
day followed by a crowd of staring children. He said he
had lost almost all hope of getting work, but came to
try the bureau as a last chance. He was only seventeen
years old, but looked to be forty. He was offered a well-
paid position as dentist's assistant, but refused it be-
cause it meant runnmg errands, and he had not the
courage to go about the streets any longer to be stared at.
Finally he was placed as an apprentice in a jewelry class,
and at once turned out to have an unusual talent for
artistic work. The teacher is delighted ^vith his possi-
bilities, and the boy writes grateful letteres about "the last
chance" that put him on his feet.
Another applicant was a very lovely girl of seventeen
who had been run over by a car and limped badly. An
unkind father at home threatened to put her out on the
street. She was found to know typewriting, and was
sent to a publisher who engaged her at twelve dollars a
week. She has stayed on there, giving satisfaction ever
since.
Another case was that of a Spanish girl of sixteen
who had been born with only one arm. She had been
studjang portrait painting on a scholarship at the
Academy of Design, but her brother enlisted and she
found she had to support herself. She used an artificial
arm and was very sensitive about the handicap. Before
her application she had tried being a messenger, had been
worked overtime, and had strange experiences taking
messages to ships. The bureau got in touch with various
real estate firms, and finally placed her as a telephone
operator and cleaner at thirty dollars a month.
One day a very lame, exhausted Italian boy came limp-
ing into the bureau on two crutches. The day was
snowy and slippery, and he had been directed to various
wrong addresses. He explained that his family were
very poor, that the father was out of work, that there
were seven children, the last one only two weeks old, and
that he wanted to leave school to help support them. He
had a slight limp following an illness, and an operation
six years before to help the lameness had greatly in-
creased it. The bureau put him in a jewelry class, but
found he could not attend on account of lack of car-fare.
This amount was contributed, and work sent to the
family. Later on, when the jewelry firms refused to
employ him on account of his two crutches, he was put
into a brace and then successfully placed at enameling.
He now helps to support his family, and goes to school
in the e/enings.
At the end of a year of experiment, with October once
THE MODERN HOSPITAL
405
more on the horizon, the working thesis of the bureau
seemed definitely proved. Though in a very small and
inadequate way, it had demonstrated its theory. One
hundred and sixty-eight crippled men and women had
been given definite means of support. And what had
been done in a small pioneer way might be done far more
effectively on a larger scale. As jeweler, as machinist, as
clerk, and as factory hand, the cripple had proved that
he could earn a fair wage and be an asset in industry.
In other words, he need no longer stand as a pariah out-
side the working world. He need not figure in the public
mind as the beggar selling shoe-laces or asking for pen-
nies on the street. Nor need he figure in the mind of
the employer as an object of charity, given a job out
of pity and counted zero as an industrial factor. Most
important of all, he need not think of himself in any such
roles. The work of the bureau has justified a new point
of view toward the cripple in general. It proves him to
be a man whom accident has handicapped in some par-
ticular manner and i-educed to subnormal, but whom
physical care, mechanical devices of some kind, industrial
training and employment placement, all or one of these
as he needs them, can return to the normal level, over-
come his handicap, and send him once more marching
in the industrial ranks. He can in the end keep step
with the rest of the column. The war is going to help
him enormously by making his handicap more generally
understood and respected, by inventing new ways of
minimizing his disablement, and doing away with the old
prejudices against him. He has begun to show that he
can "come back" commercially. The war cripples, by force
of numbers and the attention such numbers focus, will
widen the trail that has thus been blazed, and will sweep
the cripples of industry along with them into their proper
places. The new road will be one which every cripple
can take toward a life of independence and congenial
work.
VOCATIONAL INSTRUCTORS NEEDED IN
MILITARY HOSPITALS
Immediate Need for Reconstruction Aides Presents Oppor-
tunity to Serve at Home or Abroad — Qualifi-
cations Necessary and Information
Regarding Assignment
Within the next few months, approximately a thousand
women will be needed in military hospitals at home or
overseas to serve as reconstruction aides in the teaching
of hand ci-afts and other subjects to disabled soldiers, and
women interested in this particular branch of the service
are requested to send applications at once to the office of
the Surgeon General, attention Division of Physical Re-
construction.
The chief requisite for this t>-pe of service is unusual
strength of character. Only those who feel themselves
able to do hard and serious work, to spend long hours
when occasion demands, to forego many of the luxuries
and comforts of normal home life, properly to subordinate
their personal interests to the good of the service, and to
cooperate with medical officers, nurses, and others in the
conduct of their work, should seek to become reconstruc-
tion aides.
The necessary qualifications for applicants are four-fold:
age and civil status, personal, physical and educational.
In the first place, aides should be between twenty-five
and forty years of age, but exceptions will be made in
cases of unusual qualification. They must be citizens of
the United States or one of the allied countries, and must
furnish two references as to character and professional
ability. If married, they can be accepted only for work
in this country.
Secondly, they must possess a knowledge of, and skill
in, the particular occupations to be taught, attractive and
forceful personality, teaching ability, sympathy, tact, judg-
ment and industry. In overseas service, particularly, an
aide will need to exhibit great ingenuity and cleverness in
connection with her work in military hospitals.
Thirdly, applicants must pass a careful physical exam-
ination made by an army medical officer. They must be
between 60 and 70 inches in height and between 100 and
196 pounds in weight.
And finally, all applicants should present the following
educational qualifications: (1) at least a secondary school
education, and preferably, college, normal or technical
ti-aining; (2) capability of giving service in Class A and
B, and ability to familiarize themselves with Class C.
Class A includes social service, library service, industrial
and fine arts, general science, English, commercial branch-
es, free-hand drawing and design, mechanical drawing, tel-
egraphy and signalling, French, manual training, agricul-
ture, music, play and games, and mathematics. Class B
includes knitting, weaving, clay and paper-machier model-
ing, wood-carving and toy-making, metal working, jewelry
and engraving. Class C covers information in military
procedure in hospitals, War Department's program for
physical reconstruction of disabled soldiers, regulations as
to insurance, pensions, etc., under War Risk Insurance
Bureau, and opportunities offered by Federal Board for
Vocational Training.
Aides will be divided into three classes: aides, head aides
and supervisors. Head aides will be placed in charge of
each ten aides assigned, and supervisors will be appointed
in cases where there is need for extended supervision. As-
signment will be made to any hospital in the United
States, entirely at the discretion of the Surgeon General.
Overseas service will be given only where desired.
Home service will be compensated at the rate of $50
per month and foreign service at $60, with $15 additional
for head aides. Quarters and rations will be furnished
and uniforms soiled on duty will be laundered. Where
quarters and rations are not furnished, aides will receive
additional pay at the rate of $62.50 a month. Supervisors
will receive $1,800 a year, without subsistence. All aides
will receive transportation to point of destination.
Appointments will be made for duration of war and for
such further time as is deemed necessary, and the working
day will be ordinarily eight hours, but may be longer if
occasion demands. Annual leaves of absence with pay
will be arranged where possible, and allowance will be
made for personal illness not to exceed thirty days an-
nually. Medical ti'eatment will be furnished when serv-
ing under orders.
Aides will be placed under the control of the educational
director, and in personal matters and quarters are sub-
ject to the same rules and regulations as nurses. For
sufficient cause they may be dismissed from the service.
Foreign service requires both hospital and street uni-
forms, but part of the overseas equipment will be sup-
plied without cost by the Red Cross. Home service re-
quires only hospital uniform, which may be purchased
through the Red Cross for a sum well under $50.
Individual correspondence is invited, addressed to the
Surgeon General of the Army, Attention of Division of
Physical Reconstruction, Washington, D. C.
A contingent of Japanese nurses has been sent to Vla-
divostock by the Japanese Chapter of the American Red
Cross.
406
THE MODERN HOSPITAL
[.ducted by LULU GRAVES.
Please address items of news and inquiries regarding Department of
Dietetics to the editor of this department,
pital. Garland Building, Chicago.
of The Modern Ho
REPORT OF THE MEETING OF THE AMERICAN
DIETETIC ASSOCIATION
First Annual Meeting Held at Atlantic City in Conjunc-
tion with That of American Hospital Association —
Results Accomplished and List of Those Present
The American Dietetic Association held its first annual
meeting at the Royal Palace Hotel at Atlantic City, Sep-
tember 26 to 28.
A preliminary business meeting was held Thursday at
11 a. m., and Thursday afternoon the following program
was presented:
"Conservation in the Planning of Diets," by E. V. Mc-
CoUum, School of Public Health and Hygiene, Johns Hop-
kins University.
"The Dietitian in Social Service," by Lucy H. Gillett,
director Dietetic Bureau, League for Preventive Work,
Boston. In the absence of Miss Gillett, this paper was
read by Miss Blanche Joseph of Chicago.
"The Dietetic Needs of Today," by Martha Van Renn-
selaer, U. S. Food Administration, Washington, D. C.
MISS LULU GRAVES,
President American Dietetic Asj
MISS LENNA COOPER,
Vice-President American Dietetic Association.
At the regular business meeting Friday morning. Miss
Smedley gave the report of the committee on resolutions,
and a motion was made and carried to adopt such report
as given. After a discussion on sectional work, it was
decided to organize the sections as follows: dietotherapy,
administrative, social service, and teaching. A motion
was made and carried that the president appoint a mem-
ber of the executive committee as chairman of each of
these sections. In the very lively discussion of the train-
ing of the student dietitian, which followed immediately,
the following points were brought out: nature of train-
ing, length of course, hospital facilities, conditions of
living, etc. The report of the committee on revision of
constitution and by-laws was given by Miss Cooper. A
copy of the revised constitution follows. Since Miss
Perry, the former corresponding secretary, left for over-
seas service, the work of both secretaries has been done
by one person in an apparently satisfactory manner, and
it was therefore recommended that only one secretary be
elected. It was also recommended that dues be raised to
two dollars per year. The recommendations of the com-
mittee were adopted.
The committee on nominations presented the following
ballot, which was accepted by the association: president.
Miss Lulu Graves, Home Economics Bldg., Cornell Uni-
versity, Ithaca, N. Y.; vice-presidents. Miss Lenna Cooper,
Battle Creek, Mich., and Miss Violet Ryley, Montreal Can-
ada; secretary, Miss E. M. Geraghty, New Haven Hospi-
tal, New Haven, Conn.; treasurer. Miss Emma Smedley,
142.5 Bandywine Street, Philadelphia.
Friday afternoon the following program was given:
"Conservation in Dietary Calculations," by Caroline
Hunt, Home Economics, Department of Agriculture,
Washington, D. C.
"The Dietitian in War Service with the Red Cross," by
THE MODERN HOSPITAL
407
MISS E. M. GERAGHTY,
Secretary American Dietetic Association.
Edna White, Head of Home Economics Department, Ohio
State University.
In the absence of Miss White, this paper was read by
Miss Emma Conley, and proved the occasion for a
renewed discussion on the training of the student
dietitian. The question of the intensive training
courses for college women was brought up, and the gen-
eral feeling seemed to be that it is better to give hospital
training to women already graduated from reputable
schools of home economics than to devote the energy to
untrained women. The hope was expressed that the hos-
pitals of the country would realize the necessity of open-
ing their doors, as a patriotic duty, to student dietitians,
provided that their dietary departments and the person-
nel of these departments are such as would permit offer-
ing favorable training for these women. Not only is this
a patriotic service, but it is also a genuine war-time econ-
omy, as these students are capable of handling the food
conservation problem in such a manner as to give the hos-
pitals a value not measurable in dollars and cents; other-
wise, they may be called upon to give up their present
dietitians, for the government needs must be supplied. A
motion was made and carried that the association send a
representative to Washington to confer with the proper
authorities in regard to the scope of training which hos-
pitals should offer in order to render greatest value to
the army, and Miss Lulu Graves was appointed to fulfill
the commission.
The joint session of the American Hospital Association
and the American Dietetic Association was held Friday
evening, Miss Lenna Cooper of Battle Creek presiding.
After the transaction of some business by the American
Hospital Association, Mr. Henry C. Wright, secretary of
the New York State Charities Aid Association, spoke on
the work of the Institutional Food Conservation Commit-
tee, Mr. C. S. Pitcher, Kings Park State Hospital, read a
paper on "Waste of Food in Hospitals," and Miss Lulu
Graves gave a paper on "The Management of the Dietary
Department," which is published in this issue of The
Modern Hospital.
Saturday morning a meeting of the Executive Commit-
tee was held and the following appointments made: chair-
man program committee, Miss Lenna Cooper; chairman
membership committee, Miss E. M. Geraghty; chairman
section of dietotherapy, Miss Margaret Sawyer; chairman
section of teaching, Miss Katherine Fisher; chairman sec-
tion of administration. Miss Emma Smedley; chairman
section of social service. Miss Blanche Joseph.
The time and place of the next meeting will be an-
nounced later.
When leaving, the greater number of members and
delegates expressed the keenest appreciation of the value
of the meeting and unbounded enthusiasm for the future
of the association. The thanks of the organization are
due Miss Graves for her splendid administration during
the initial year. It is seldom that an association accom-
plishes as much in one year as this association has. Miss
Graves has not only been a leader in the affairs of the
body, but, through this medium, has also done much for
the advancement of the profession.
E. M. Geraghty, Secretary.
THE RED CROSS DIETITIAN SERVICE *
Its Work and Method of Providing Dietitians for Overseas
Service, as Well as for Cantonments and Military
Hospitals in the U. S. — Plans for the Future
By EMMA CONLEY, Chairman of Advisoi-y Red Cross Dietitian Com-
mittee, States Relation Service, Department of
Agriculture. Washington, D. C.
The Red Cross Dietitian Service was established by
Miss Jane A. Delano early in 1917, before our entrance
into the war, as a part of the Nursing Service of the
Red Cross. Its purpose at that time was to provide
ntion of the Am
Dietetic
HI
■
^^^^Bp
- ti
^^1
^^^■y^
1
^1
^Ha
n
^^^^m ^- A
^
^^^
14.
iJH
MISS EMMA SMEDLEY,
American Dietetic Associati<
408
THE MODERN HOSPITAL
trained hospital dietitians for the base hospital units
then being organized by the Red Cross for overseas serv-
ice and to furnish trained home economic teachers as in-
structors for classes of women who were studying home
dietetics under the supervision of local Red Cross Chap-
ters. This course was intended to supplement the course
in elementary hygiene and first aid, and an elementary
text book was compiled and distributed by the Red Cross.
It has been extended by the addition of three new out-
lines, War Diet in the Home, Emergency Cooking, and
Course for Children, and about one thousand instructors
have been registered as willing to undertake this teach-
ing. When the United States entered the war, about
twelve dietitians had been assigned to hospital units and
during the summer the list of the fifty units was com-
pleted, one dietitiian being assigned to each. Many of
these units are now overseas.
Early in 1917 the enrollment of dietitians at the Red
Cross Headquarters was about one hundred, nearly all
of whom desired hospital service. Since then, the enroll-
ment of teachers for the home dietetic course and those
experienced in institutional work has increased to 1,630
at the present date, with about six hundred applications
pending. About one thousand of these are instructors
in the home Red Cross Chapter course, and over three
hundred are dietitians in service in the army and navy
cantonments and in overseas hospitals.
Since our entrance into the war, the Red Cross Dieti-
tian Service has been extended to provide dietitians for
additional base hospital units, for cantonment army and
navy hospitals in the United States, and for military hos-
pitals in this country. It has also been asked to provide
dietitians for the thirty-five army schools of nursing.
In this matter the Red Cross Dietitian Service acts as
a clearing house. The candidates register with the Red
Cross Bureau, their fitness for sei-vice is investigated and
certified to, and they are then recommended for service to
the Surgeon General of the U. S. War Department. If
they are accepted for army or navy hospital service, they
become part of the military service of the United States
and are transferred from cantonment to foreign service,
or from one place to another in this country, at the dis-
cretion of the Sui'geon General's office.
Dietitians requesting information about how they may
serve are sent a circular of information and a set of ap-
plication blanks. If they have had teaching experience
they are listed as instructors. If their experience has
been in hospitals, or other institutions (including cafe-
teria work) , they are asked to send in a physical exam-
ination record, and are listed as eligible for military hos-
pital appointment. The bureau then sends for the school
and other credentials, and the endorsement of the Com-
mittee on Dietitians for the Red Cross is secured. A
formal enrollment card is sent to those who meet the re-
quirement of two years' of household economic training,
or equivalent, and subsequent teaching or institutional
experience. Those listed as instructors are also given
an Instructor's Appointment card, and their names are
sent to the Red Cross, Division Directors of Nursing Serv-
ice, as are the names of those granted temporary author-
ization as instructors. These lists serve in advising
chapters where to find instructors, and confirm any choice
a chapter may make. Those who received only the en-
rollment card are told they will be notified of oppoi-tuni-
ties to serve under military direction or under the Red
Cross organization abroad.
Applicants who do not fully meet the requirements are
placed as reserves, and informed that their applications
may be withdrawn for reconsideration after they have
completed further training or secured additional experi-
ence.
Our committee has found that several things seem ad-
visable to insure good, well trained dietitians for war
service and have them in readiness when the Surgeon
General's office may call for them. There should be a
list of the recognized schools for training dietitians so
that qualifications may be more easily passed upon. The
list of hospitals offering to take pupil dietitians should
be extended, so that those who have had the required edu-
cation may get the required experience under conditions
similar to those which they will meet in war service, and
courses should be started in our best equipped colleges
and schools which will offer three or four months' in-
tensive training to graduate dietitians who lack only the
necessary practical training. This work is not within the
province of the Red Cross Dietitian Service Committee,
but some members of the committee, seeing the immediate
needs, met with Miss Van Rennselaer of the U. S. Food
Administration recently and outlined a course which was
planned to insure the furnishing of well trained dietitians
for war emergency service.
Requirements for and Outline of College Course for
Dietitians
The following is the outline of the course referred to
in Miss Conley's article, together with the requirements
for admission:
REQUIREMENTS FOR APPLICANTS TO THE COURSE
Age. — Twenty-five, except in cases of younger women of exceptional
experience.
Experience. — Practical knowledge of food and four months" experience
in a hospital. This may follow the course.
Education. —
1. At least a two-year course in home economics, in advance of high
school training, given by some institution of recognized standing,
and proved executive ability preferably in food work, or —
2. A bachelor's degree from an institution of recognized standing and
a strong foundation in science.
3. The proved equivalent of 1 or 2.
Personal Qualifications. — Vigorous health, strong moral character, proved
executive ability, power of initiative and leadership.
References. — Three from faculty members of the institution from which
the candidate was graduated.
One or two employers.
One from clergyman or prominent citizen. These references are
not to be in the form of recommendations but names of persons
to whom questions may be put concerning ability of applicant.
OUTLINE OF COURSE FOR TRAINING DIETITIANS FOR MILITARY HOSPITALS
Section I. Institution Organization and Management.
Part A. Organization —
Camp
Hospital
Auxiliary Organizations
a. Red Cross
b. Y. M. C. A.
c. Knights of Columbus
cafeterias.
Part B. Militaiy Rules and Regulations
Camp and cantonment
Hospital
Canteen and cafeteria
Miscellaneous.
Part C. Management
Buying
Supplies — Equipment
Inspection — Marketing
Storage
Accounting
Bookkeeping
Office filing
Records and reports (keeping of)
Inventorying
Managerial
Responsibilities, direction of help, snpervision, preparation and
and service of food, menus and special diets.
THE MODERN HOSPITAL
409
Section II. French or Italian
Section III. Foods
Principles of cooking applied to
a. Small quantities of food
b. Large quantities of food
Section IV. Nutrition and Dietetics
Part A. Nutrition
a. Food as a source of energy
b. Food as a source of material for tissue
c. Food as a source of regulating substance
d. Various constituents of the diet
Meats
Cereals
Vegetables and fruit
Fats
Sweets
Part B. Dietetics
a. Menus
b. Diet in disease
Constipation
atony
spastic colon
Dysentery
Diabetes
Nephritis
Phthisis
Infections from intestine
rheumatism
neuritis — sciatica
c. Diet for infants and children
Supplementary for reconstruction workers
Section V. Science
Part A. Sanitation and hygiene
Part B. Pathological chemistry (clinical tests)
A course of study, which may be recommended for use
in hospitals as a supplement to the technical training in
colleges, is also being prepared. It will be submitted to
the Army Nursing Department and the Surgeon-General
as soon as it is completed. If it meets with approval,
steps will be taken to have it adopted in all hospitals
having facilities for offering student dietitian training.
NEWS NOTES OF DIETITIANS
Miss Irene Enders, formerly dietitian at Greenwood
Hospital, Greenwood, S. C., is now dietitian at Western
Pennsylvania Hospital, Pittsburg, Pa.
Miss Elizabeth Given, who has been assistant dietitian
with Mrs. O'Dea at Johns Hopkins Hospital, is studying
at Columbia University this year. Her chief interest is
the course in Nutrition offered by Teacher's College. Miss
Jean Bradley will be Miss Given's successor at Johns Hop-
kins.
Miss Margaret Deaver, dietitian at Mt. Sinai Hospital,
Cleveland, Ohio, has been ill for several weeks.
Miss May Miller of St. Luke's Hospital, Cleveland, Ohio,
has been doing Y. M. C. A. work in Canada, having been
granted leave of absence for this purpose.
Miss Lulu Graves will be in the home economics depart-
ment of Cornell University the coming year, helping to
establish the course of training for dietitians which is to
be introduced this year.
Miss Violet Ryley, formerly of the. Military Hospitals
Commission of Canada, has been appointed chief dietitian
of our camps and base hospitals. Miss Ryley's experience
makes her well fitted to standardize the work of the
dietitian in army service, and we are very glad to have
this much needed work given into her hands. We do not
know her official title, but understand that she has as-
sumed her new duties.
Flavored Gelatine Food Products Recognized by United
States Food Administration
Superintendents and dietitians who have had consider-
able difficulty during i-ecent months in securing flavored
gelatine products because of the restrictions which the
Sugar Division of the Food Administration placed on
manufacturers of these preparations, will be relieved to
know that the Food Administration has ruled that gela-
tine products for hospital use are essential. The earlier
ruling, under the terms of which during the latter half of
1918 manufacturers were permitted to use only 50 per-
cent of the amount of sugar that was actually used for
the corresponding period of 1917, was modified in order to
permit hospitals to serve this class of gelatine prepara-
tions to the sick and convalescent. In harmony with the
desires of the Food Administration and the wise policy
of the conservation of sugar wherever possible, it is an-
ticipated that hospital officials will see that gelatine
desserts containing sugar will not be served to any per-
sons in the institution except patients.
ADVERTISING THE PUBLIC SANATORIUM
Minnesota Taking Progressive Steps in Publishing Essen-
tial Facts and Figures — Suggestions for Institutional
Advertising Which Will Bring Desired Financial
Results
In order to get results with our public institutions we
must follow the example of the owners of private sanato-
riums by advertising to the public what we have to offer.
The laity in general must be advised regarding the pur-
pose and equipment of the institution, and they should
not only be invited, but requested, to visit the institution
in their locality.
Minnesota is taking the lead in building model sana-
toriums for the tuberculous, which are run on a most ef-
ficient business basis and are under the supervision of
well-trained administrators. A great amount of the
credit for present conditions is due Dr. Robinson Bosworth
and the Advisory Commission. In a great many instances
the local sanatorium commission also is most enthusiastic
and cooperates with the state authorities for the good of
the sick. The burden of the local work falls upon the
president of the sanatorium commission, who gives his
time gratuitously and even goes to great personal expense
because of his extreme interest in the project. I want to
express my appreciation to the commission with which I
am connected — and especially to the president, Dr. J. T.
Thabes — for their interest in the institution and coopera-
tion in its management.
The uninformed public has felt that a county institu-
tion would not be a fit place to send their relatives, that
it was established for fundamental purposes of graft, or
that it was run exclusively by some religious sect.
These ideas must be changed and the public must see
things in the right light, so that the institution may
be filled. One effective measure consists of picture
post cards of the institution distributed to people of
the surrounding community, inviting them to visit the
institution, where they will be shown all points of interest,
especially the method of handling the business end of the
work, the menus and the preparation of food, and the
accommodations for patients.
Properly written newspaper articles, repeated at in-
tervals, and lectures before the chamber of commerce and
all societies, not only on how to prevent and diagnose
tuberculosis, but also about the institution, its origin, how
much it is costing the community, and the good that it is
doing- especially in certain extraordinary cases — will
stimulate the public to sympathize with the project and
insure the appropriation of the necessary amount of
money for its maintenance.
410
THE MODERN HOSPITAL
Conducted by ANNIE W. GOODRICH. Dean Army School of Nursing
and CAROLYN E. GRAY. Principal City Hospital School ol
Nursing. Blackwells Island, New York.
Please address items of news and inquiries regarding Department of
Nursing to CAROLYN E. GRAY. Principal City Hospital School of
Nursing, Blackwell's Island, New Y'ork.
The Nursing Program of the Army*
By ANNIE W. GOODRICH, Dean. Army School of Nursing.
To say that this is a time for deeds and not for
words is not only to utter a platitude; it is to state a
hard, cold fact. To add that the success of the required
deeds depends upon the effective cooperation of all the
agencies involved, best obtained through a sympathetic
understanding of the proposed program, is not only to
utter a second fact, but to present the words which
are an important part of the machinery necessary for
the consummation of the required deeds; hence, our
absence from an arduous post to outline in the fewest
possible words the nursing program of the army.
THE PROBLEM
By July 1, 1919, five million men engaged in the most
hazardous of occupations must be provided with a nurs-
ing staff sufficient to prohibit any loss of life or crippling
of mind or body that can be prevented through nursing
care. Simple to state — yet a demand never before made
in the history of war or of nursing — a demand perhaps
quite impossible to encompass, and one dependent not only
upon the existing nurse power of the country expressed
in numbers and efficiency, but also upon the provision of
hospital beds and housing capacity for nurses overseas
and on this side, and upon overseas transportation
facilities.
Our province is limited to the question of the numbers
and efficiency of the nurse power of the country to meet
this demand. There is probably no one present who is
not familiar with certain statistics relating to the nurs-
ing situation, namely, that there have been registered
in the United States, since laws regulating the practice
of nursing came into effect (the first in 1902), ninety-eight
thousand nurses; that a reasonable subtraction for
"dead wood" has been said by statisticians to be 10
percent, leaving eighty-six thousand nurses who should be
available; that there are 1,57,') accredited training schools,
and that these schools graduated approximately fifteen
thousand students in 1917; that the Surgeon-General is
asking for twenty-five thousand graduate nurses by
January 1, 1919, and a total force of fifty thousand
nurses by July 1, 1919; and that this number has been
deemed by some to be insufficient.
In view of the fact that the schools of nursing in
this country have not yet celebrated their fiftieth anni-
versary, that there should already have been established
the machinery through which such a demand could be
efficiently met, is, despite any criticisms of failures to
measure up immediately, a cause for congratulation.
The establishment of the Army Nurse Corps (female)
by an Act of Congress, 1897, and the later provision
that the enrolled nurses in the American National Red
Cross Nui-sing Service should constitute the reserve of
the Army Nurse Corps, has- provided the machinery
through which the superintendent of the Army Nurse
Coi-ps, Miss Doi-a Thompson, presented on September 20,
1918, an enrollment of 17,197 graduate nurses. I think
I am not mistaken in saying that this is the largest body
of graduate nurses in any country or gathered to-
gether for any cause. She should be here herself to
present in detail what may be well, I believe, defined
as a stupendous achievement. The work of this en-
rollment proceeds rapidly, silently, and efficiently, and
any study of the statistics shows that at no time has
there not been a large number of nurses waiting trans-
portation overseas, which must mean that any shortage
at present existing on the other side, whatever may be
the condition later, is not due yet to a failure of the
Army Nurse Corps to provide a sufficient body of nurses.
It is of a moment's interest to review briefly the statis-
tics relating to the Army Nurse Corps: On July 31,
1916, the report showed 162 enrolled nurses; in August,
1916, that number had risen to 332, about .50 percent
of which were in the hospitals on the Mexican border.
On August 31, 1917, the report showed that the total
number of nurses enrolled was 1,631; approximately 331
were in the home service, 176 on the Mexican border,
476 with the British forces, 422 with the American
Expeditionary Forces, and some two hundred and thirty
awaiting transportation. The figures for 1918 read very
differently: On August 16, the total enrollment was
14,31.5, and on September 13 — a month later — it was
16,090. I have just given you the figures for Septem-
ber 20, which showed an enrollment of 17,197. Within
the past few months the number awaiting transporta-
tion at the port of embarkation has rarely fallen below
one thousand, and on September 20 was iwelve hundred.
It is not unreasonable, we believe, to expect an enroll-
ment of twenty-five thousand graduate nurses by January
1, 1919. But it is obvious that the enrollment of all the
graduate nurses possible, draining all the resources of
the country, will not provide the total number needed
according to the program. It is because this has been
realized that new machinery has been established, and
I presume it is mainly this upon which you desire a
report. Briefly defined, the purpose of the Army School
of Nursing is for the immediate improvement of the
nursing care of the sick in the military hospitals and
for an adequate expansion of skilled nursing service.
While the establishment of a school of nursing is a
new project from the standpoint of the army, it is by
no means a new and untested method of caring for the
sick. Had the problem of the sick and wounded, repre-
sented by five million men engaged in a hazardous oc-
cupation in a civil community been presented, we would
have thought immediately in the terms of hospitals
staffed by one-fourth graduate nurses as a maximum,
and the remaining three-fourths student nurses. Rich
indeed would we have felt ourselves with such a propor-
tion! If we were thinking in these terms today, twenty-
five thousand graduate nurses would mean seventy-five
thousand students. And had we planned to carry on the
school according to the methods which had already given
the greatest return in efficiency, we would have made the
high school requirements and included in our program af-
filiations for the services which could not be obtained
* Read before the Twentieth Annual Convention of the American
Hospital Association, Atlantic City, Sept. 24-28, 1918.
THE MODERN HOSPITAL
411
through our hospitals. In establishing the Army School of
Nursing, we have in no way deviated from the existing and
accepted-as-best methods in the civil training schools,
except that we have at no time conceived that our pro-
portion of student nurses would bear the same relation
to the graduate body that the proportion of student
nurses in the civil hospitals bears to their graduate
bodies.
Not until very recently, when Colonel Finney brought
a message from the other side, did we conceive
that the thought of those over there, without knowl-
edge of our program here, was following exactly the
same, or certainly very similar, lines as the thought
of those studying the situation here. It is, I think,
correct to state, following Colonel Finney's report, that
a considerable body of the best experts in the subject
are feeling that the work on the other side would be
more efficiently carried on if the plan followed closely
that of the civil hospitals. It is because of this fact that
again the program of the .4rmy School of Nursing has
been expanded and, in addition to the enrollment of a
student body of its own, is presenting to the civil hos-
pitals the suggestion that they think in terms of af-
filiation for their pupils to obtain the e.xperience in the
military service. The details of this proposition we shall
return to later.
For the moment, let us consider further the problem
before us. The chronic and convalescent institutions in the
civil communities have never been felt to be a good
teaching field. The problem of the chronic and con-
valescent hospitals, with this body of five million men,
again presents itself, and presents itself in more im-
portant terms than any previous problem of this nature.
In thinking of a plan whereby we could cover this need,
we conceived the thought that a group of persons not
eligible as students might be used very effectively in
this situation; hence the plan for hospital assistants.
We have, then, briefly summed up, before us this
proposition: The largest possible group of graduate
nurses ; the largest possible group of student nurses,
graded through affiliation with the civil hospitals (a
body not less large than the graduate body, and, if it
in any way approximates the situation in the civil com-
munity, at least 50 percent larger), for the acute
service; and, for the convalescent and chronic service, a
special group not to be known as, or meeting the qualifica-
tions for, student nurses.
SUPPLY
Considering the supply from the standpoint of the
enrollment in the Army School of Nursing, the entrance
qualifications for which are twenty-one to thirty-five
years of age, and, educationally, the completion of four
years of secondary work, we turn to the statistics pre-
sented by the United States Commissioner of Education
relating to the number of girls in the secondary schools
and in the colleges and universities of the country. We
find that in 1915-16 the total number of girls enrolled
in 12,003 high schools was 795,420, and of this number
119,660 were in the fourth year. In 2,118 private high
schools the total number of girls was 79,249, and of
this number 14,984 were in the fourth year, presenting
the number graduated yearly from the high schools, as
134,644.
The tables relating to the number of undergraduates
and graduate students in public and private universities,
colleges and in technological schools in 1915-16 present
95,436 women.
It is not impossible to conceive that out of this num-
ber could be achieved an enrollment of fifteen thousand
students, or even twenty thousand in the Army School of
Nursing by June 30, 1919. We contend that it would cer-
tainly not be impossible to obtain if it were drafted. Not
any more than it is conceived impossible to draft five mil-
lion men, would it be impossible to draft thirty thousand
to forty thousand students. We do not believe that this
would be desirable, nor do we believe that this number
will be necessary.
THE APPEAL
The appeal to the young women of the community is a
very heavy one. They are anxious to give a definite ser-
vice, and the great majority of letters which are re-
ceived indicate an appreciation of the plan whereby their
services are to be utilized. There is a group which has
no conception of what trained service means, and which
considers that the volunteering of a certain number of
hours of work is a generous gift. I am glad to say that
this attitude of mind represents only a small minority
and that, in the main, we are enrolling young women who
have been disciplined by years either in educational in-
stitutions or in the occupational and professional field.
Every report that comes to us from the hospitals in which
these students are now on duty (and there are now well
over four hundred students) emphasizes the fact that we
are dealing with an earnest and intelligent group of
young women who are bound to "make good." From one
base hospital now seriously stricken with influenza the
report comes that all classes have been temporarily dis-
continued— as, of course, they should be — and that the
students are giving full time on the wards and are of
value.
STATISTICS
We believe that the statistics we have to present bear
out our contention as to the possibility of enrolling the
required student body. The school was approved on May
25, 1918; the first literature concerning it was issued on
June 7, and the applications began to come in, in small
numbers, early in July. The number being filed weekly
has increased rapidly, until we now have received,
according to the memorandum submitted to the
Surgeon-General on September 21, 1918, 8,233. Of this
number, 2,500 have been accepted — all high school gradu-
ates or an excellent equivalent, and many one or more
years of advanced work. Two thousand and ninety-four
have been rejected, and 3,639 are still under considera-
tion.
Our aim was to place on duty by October 1 one thou-
sand students. I do not believe that this number will be
actually in the field on that date, but I believe that by the
end of the first week in October the number will be fully
realized ; and I know that the lists of students to be
called (a little beyond that number) will be in the hands
of the commanding officers of hospitals almost, if not en-
tirely, ready to receive them.*
Our further goal is to place five thousand students on
duty by January 1. I dare to believe that, with two thou-
sand five hundred accepted applications, this, too, may
be realized.
RECRUITING AGENCIES
It would be, of course, impossible to conceive that this
could be the case were it not for the recruiting machin-
ery. We have — first and most importantly — the Division
Directors of the Red Cross, who have from the very be-
ginning of the establishment of the school directed stu-
*Owinff to the influenz
called immediately. Over
are awaiting calls.
412
THE MODERN HOSPITAL
dents to us. In addition to this, and to which we are in-
debted for the immediate and large increase in our en-
rollment, we have the United States Student Nurse Re-
serve "drive" carried on by the Woman's Committee of
the Council of National Defense, with the assistance of
the Red Cross and the approval of the Surgeon-General's
Office. Here again we have an organization like the Red
Cross, which has its divisions in every state and in many
local communities. The recruiting, although the great
"drive" has been closed, this organization proposes still
to continue, as I understand it, as long as there is a need.
In addition to this, there has been recently made to the
colleges of the country an appeal by the American Coun-
cil on Education, with the approval of the Surgeon-Gen-
eral, to put in their curricula pre-nursing courses, and a
definite quota of students is being called for — two thou-
sand by October 1st, four thousand in the January classes,
and five thousand in the spring. These courses are to be
on the Vassar plan. The American Council of Education
is using its machinery to help in the establishment of
these courses and in the enrollment of students, and it is
believed this will be one of the most important sources of
supply, because of the type of women it will bring to us,
and also because it will relieve us of much of the theo-
retical work of the preliminary four months' preparation
and enable us to put these students for almost their entire
time on the wards.
AFFILIATIONS.
One of the most important matters, from the stand-
point of the Army School, is the suggested affiliation. It
must be clearly understood that these affiliations are only
desired if the hospitals see in them an opportunity to give
their students a much desired experience — and, while
giving them this experience, an opportunity of taking in
more students, thereby making their schools take a part
in both the military and civil service.
Briefly presented, the proposition is that the Army
School of Nursing offers an experience in the military
hospitals where training school units are established, to
students in accredited schools of nursing who are twenty-
one years of age and who have had not less than two
years of secondary work. The arrangements will not
differ materially from those made between affiliating
schools of nursing. The course will extend over a period
of not less than four months. The experience will sup-
plement the experience in civil hospitals in medical and
surgical nursing, communicable, mental and nervous dis-
eases. The purpose of the course is to familiarize the
students with the nursing system of the army.
Students who have completed the services not obtain-
able in the military hospitals, namely, obstetrics, pedia-
tries, and gynecology, can remain for a longer period if so
desired by the parent hospital, and will therefore be eli-
gible for service overseas. Students who are within four
months of their graduation before entering the military
hospital may be enrolled immediately upon the completion
of that period, if their record is satisfactory, in the Army
Nurse Corps, and will also then be immediately eligible
for overseas service. Students who return to the civil
hospital upon the completion of their four months' ex-
perience will have the advantage of being conversant with
the military system and will also, therefore, upon gradua-
tion be ready for immediate service overseas.
Monthly Alloicance. — The same allowance will be paid
these students during the period of affiliation that is paid
the students in the Army School, namely, $15.00 a month.
Transportation — It may be arranged that the Govern-
ment can pay transportation expenses, certainly in the
case of students transferred from one base hospital to an-
other or sent overseas. Students will be assigned to a
military hospital in the locality of the civil hospital when-
ever possible.
Uniform.— The students will wear the nursing uniform
of their own hospital. In case of their being sent over-
seas they will be equipped with the military uniform. Ad-
ditional military uniforms beyond the first provided will
be paid for out of their allowance.
Record of Work. — A record of the theoretical and prac-
tical work, together with an efficiency record, will be sent
to their training school upon the completion of the course.
Z)!7)?o»na.— Students will receive the diplomas of their
own schools.
The arrangements for the students of the hospitals
which have sent base hospitals overseas, and which hos-
pitals have recently received a letter from the Sui-geon-
General's Office, following Colonel Finney's report, differ
slightly, and the following recommendations have been
made:
That upon graduation of these students they will re-
ceive the diploma of their own school;
That the instruction they are to receive will be ar-
ranged by the superintendent of the training school with
the chief nurse of the hospital unit;
That these students will be sent to their own base hos-
pital overseas;
That only those senior students should be assigned who
desire to remain in the service upon the completion of
their coui-se.
Intermediate Students. — One or two hospitals desire to
send intermediate students, to be returned at the end of
a year's service and to be replaced by others should their
services still be needed. As this plan would enable these
institutions to send a larger number of students, it is be-
lieved it would be desirable if it could be adopted, these
students to receive the monthly allowance given to students
in the Army School of Nursing, namely, $15.00 a month,
transportation expenses to be provided by the Govern-
ment, the students to be permitted to wear the uniforms
of their own schools, the military uniform and other
equipment to be provided, and the selection of these stu-
dents to be left to the authorities of the schools, with the
requirement that they shall be twenty-one years of age
and that they and their parents are willing that they
should go.
Hospital Assistants. — At a recent meeting of a special
committee to discuss the question of the part the civil
hospitals are to take in the military situation, the com-
mittee approved of the general plan for affiliations as
just presented. Dr. Gold water not voting because repre-
senting at the meeting the Hospital Association and not
being therefore in a position to express an opinion until
the matter had been formally presented to this body.
At the meeting of this special committee, also, a resolu-
tion was presented by Dr. Goldwater and was unani-
mously passed, which reads as follows :
Resolved, That civil hospitals which have the necessary
facilities be encouraged to arrange for the training and
use of hospital assistants according to the plan and quali-
fications of the Army School of Nursing;
That such hospital assistants be enrolled through the
American Red Cross, with the understanding that they
will accept service as required whether in the hospitals
in which they are trained, with the American Red Cross,
or in the army hospitals.
The plan and qualifications as referred to in the motion
provided that candidates for admission to the hospital as-
sistants' service must be married women between the ages
of twenty-one and forty, whose husbands are overseas,
and who are free to give this service; also single women
between the ages of thirty-five and forty-five. All candi-
THE MODERN HOSPITAL
413
dates must be in good physical condition and of good
moral character. They must be graduates of high schools
or present an acceptable equivalent.
We have not yet any important report to present con-
cerning this group. We believe it to be a valuable one,
and we are counting on a large enrollment. The Surgeon-
General's Office has received over a thousand letters of in-
quiry, many of them from very desirable candidates. The
hospitals to which these workers are to be assigned are
not yet determined upon, but we believe they soon will
be. They will be assigned to convalescent hospitals in
this country where training school units are not to be
established. Applications of candidates eligible for en-
rollment in schools of nursing will not be considered for
this service.
We cannot close without a brief expression of apprecia-
tion for the contribution the civil hospitals have already
made. There are many difficulties which have presented
themselves in establishing the ti'aining school units in the
various military hospitals, the chief of which was the
obtaining of training school superintendents so thoroughly
conversant with the problem that they could, with the
least possible delay and under handicapping circum-
stances, accept and establish groups of students. Women
upon W'hom the demands of the past year have been ex-
ceedingly heavy owing to the release of their graduate
nurse body in large numbers, upon whom they depended
for teaching and supervision, have foregone their vaca-
tions in some instances and, through the generosity of
their boards, have been permitted to come into our service
and establish this work. We have at every military
hospital where a training school unit has been established,
a director who is thoroughly conversant with training
school work. In a majority of instances these directors
act also in the capacity of chief nurse.
Miss Thompson has striven since the establishment of
the school, when preparing chief nui'ses, to select those
who have conducted schools and to place them in hospitals
where training school units have been established, in order
that they might master both problems at the same time.
This has been of the greatest assistance to us, and will
eventually make for the establishment in the military hos-
pitals of a system strictly in accordance with the system
in the civil training schools.
We are aware that several questions are arising in your
minds concerning this proposed gigantic body of student
nurses. Suppose that they are obtained in the numbers
desired, and that the war ceases next spring, what is to
be done with the number over and above that required in
the civil training schools and the small number that will
be required after the war in the army? No more do we
consider this an insuperable difficulty than Miss Clayton
considered the question of affiliation an insuperable dif-
ficulty. When we turned to her at the committee meet-
ing recently, as the person best fitted to speak on the sub-
ject, not only because she is the president of the National
League of Nursing Education, but because she is the
superintendent of one of the largest and perhaps most
difficult schools in the United States, she replied simply
that she saw no difficulties in it; we had all been thinking
in terms of affiliation now for a number of years, and
were used to considering such an arrangement.
Our answer concerning this large number of student
nurses, it seems to me, is not much more difficult: The
life of the military hospitals will be much longer than the
period of the war. Probably a large proportion of these
students will, upon the cessation of hostilities, drop back
into their ordinary life and pursuits. There ai'e fields of
nursing in which we should have been glad to have placed
student nurses long ago if a student body had been avail-
able. The public health field alone could care, we are
sure, for a larger body of students than will be avail-
able, and will afford an experience that can well substi-
tute for the experience in obstetrics and pediatrics, which,
it is ordinarily conceived, we must obtain through the
civil hospitals. My experience last year in Henry Street
Settlement, with its great uncovered child sickness and
the impossibility of providing a sufficient graduate and
student nurse force for the obstetrical situation in an
area limited by Fifth .Avenue to the East River in one
direction and Fifty-ninth to — I think — Seventy-ninth
Street in the other, leads me to believe that nothing bet-
ter could happen to the United States than to be com-
pelled to provide the experience in obstetrics and pedia-
trics for a larger body of student nurses than has ever
heretofore been conceived of. And I contend that this
is not the statement of a visionary! There are other un-
covered fields, the needs of which will not be diminished
by the war, in which the student nurses can still render a
service to their country until they have completed their
course, and which will provide a valuable and interesting
experience.
Army School of Nursing
In a letter to the editor, Mr. Pliny 0. Clark, superin-
tendent of the Ohio Valley General Hospital, says:
"I am enclosing some rather good prints of army
school life, which I thought you might like to use. They
"We have at present sixty-two pupils, fifty more coming
in the latter part of October, and more in December, until
this base reaches its quota of one hundred and fifty pupils.
I have been instructor of practical nursing since July, and
am enjoying it very much; there are three others in-
■|4>
Views of the Army School of Nursing, Camp Wadsworth, S. C, with a group of the pupils and a class in session.
came from Miss Nell Learned, who was formerly our structing in the different subjects, so, you see, we are
night supervisor. She is now one of the instructors at kept busy.' "
the United States Army Base Hospital, Camp Wadsworth, The very interesting pictures of the school are shown
S. C, and she writes in a recent letter: herewith.
414
THE MODERN HOSPITAL
Conducted by BARROW B. LYONS
Superintendent Delaware Hospital' Wilmin^to
WORKMEN'S COMPENSATION, HEALTH INSUR-
ANCE AND HOSPITALS
A Farsighted Discussion of the Future Relation of Charit-
able Hospitals to Industry, Indicating Vast Changes
Which the Future May Have in Store
By THOMAS HOWELL, Superintendent. New York HospitaL
Workmen's compensation has been in effect in New
York for four years. At first, hospitals, owing to in-
adequate systems and a general lack of knowledge of the
law, obtained little or no income for the treatment of
compensation cases, but they are now handling this im-
portant work in a business-like manner and are obtain-
ing encouraging results.
At the New York Hospital, which is located in an in-
dustrial district and therefore treats a large number of
accident cases, we i-ecognized early that the proper hand-
ling of this work would mean a substantial increase in
our receipts, and soon after the law took effect we per-
fected a system which we have since employed. Our
annual receipts at the Fifteenth-Sixteenth Street Hos-
pital, exclusive of fees turned over to our attending sur-
geons, have been as follows: 1915, $15,065.53; 1916,
$15,266.00; 1917, $16,474.95.
Most of our compensation patients are of the ambula-
tory type. If we were to admit to the wards accident
cases picked up by our ambulances we could probably
double our present receipts. Most of the first treatment
work is done by the admitting physicians, who are sal-
aried men. The subsequent treatments are given by the
out-patient surgeons, who receive small salaries. The
majority of the New York hospitals charge in the case
of ambulatory patients $2 for the first treatment and
$1 for subsequent treatments. There is no established
ward rate schedule. The ward rate is $2.25 per day, the
same as for other patients. In addition, we charge $3
for each X-ray plate, $5 for use of operating room, and
$5 for the anesthetic. Crutches and other appliances, and
special nursing are also charged to the employer. We
include in our bill the fee for the surgeon's services, which
is turned over to the surgeon. Under the schedule in
force at present, the largest fee allowed a surgeon is $75,
which includes first-aid, operation and additional subse-
quent treatment. Some of the New York hospitals re-
tain all professional fees, but this is obviously unfair
to the surgeons.
THE RELATION OF THE HOSPITAL TO THE EMPLOYER OF LABOR
The question is often asked whether, under the law,
hospitals can compel employers to pay for surgical atten-
tion furnished their injured employees.
When the law first went into effect, the commission
did not assume that it had anything to do with medical
bills except to pass upon their reasonableness. The Court
of Appeals, however, sustained its power to make awards
and to enforce payment of medical bills when the re-
quest is made by the employee, but the commission does
not enforce payment of medical bills when the request
is made by a hospital or a doctor; in other words, it
deals exclusively with employer and employee, and does
not recognize third parties.
However, the hospital may submit unpaid bills to the
commission for an opinion as to their reasonableness,
and, if the commission approves, the hospital is then
in a position to take the matter into court. It is rarely
necessary to take legal steps to collect bills after the
commission has declared its approval, providing of course,
that the case is covered by the law in other respects and
the employer is financially responsible. We have experi-
enced some difficulty in trying to collect in the case of
small employers who are doing business with little or no
capital.
If the employer, upon being requested to do so, refuses
to furnish treatment, the employee is entitled to obtain
such services at the employer's expense. Furthermore,
by a recent amendment, if the employer, his superintend-
ent, or his foreman, having knowledge of an injury sus-
tained by an employee, fails to provide treatment, the
injured employee may procure medical services without
further notice to the employer, and at his expense. In
every instance where it is possible, it is best to obtain
the employer's written instructions to treat the employee,
and charge the expense to him. When this written author-
ization has been obtained, there is rarely any difficulty in
collecting.
The routine procedure at the New York Hospital in
handling workmen's compensation cases is as follows:
1. When the patient applies at the emergency room
for first-aid treatment, the clerk on duty enters his name,
address, occupation, and name and address of employer,
together with the diagnosis and date of treatment, in a
book kept for this purpose. The patient is given a card
which identifies him as a compensation case, and informs
him when and where he is to return for subsequent treat-
ments.
2. The next morning the compensation clerk sends
to the employer a form letter, which gives the name of
the patient, diagnosis and some information as to what
the law requires of him. As the law requires that treat-
ments by hospitals and doctors shall be authoinzed by
the employer, these letters are of importance in a legal
way. If the hospital can show that the employer acknowl-
edged receipt of a letter, and gave instructions regarding
billing, a legal claim for services can be easily established.
3. When the patient returns for subsequent treatments
he is referred to the compensation clerk, who has on file
a card, bearing the information obtained at the patient's
first visit to the hospital. The date and nature of each
treatment is entered on this card, as well as any other
information regarding the patient that has any bearing
on the matter. The clerk tries to get as much informa-
tion as possible from the doctor regarding each case so
that she is prepared to answer telephone inquiries at any
time during the day and to make out the certificates re-
quired by the employee and the insurance companies at
any time they ai-e requested. All certificates are made
out by this clerk and signed by her in the name of the
superintendent of the hospital. " This eliminates confusion
in giving out information and saves the doctors a great
deal of clerical work. When the treatment of a case is
finished, the bill is promptly sent out.
HEALTH INSURANCE INEVITABLE
This country has successfully made the first step in
social insurance — workmen's compensation. The next step
is to provide health insurance.
Far-seeing employers have in many instances devised
and adopted health insurance measures for their em-
THE MODERN HOSPITAL
415
ployees, but small employers have not been in position to
do so. Compulsory health insurance, however, would
provide for the employees of the smallest employer, as
well as for those of the largest employer. It is esti-
mated that from 70 to 80 per cent of those gainfully em-
ployed would be included in the benefits of this form
of insurance. Statistics would appear to indicate that
wage-earners, who will be the ones to benefit by health
insurance, have higher morbidity and mortality rates than
do the mercantile and professional classes. Accordingly,
they ai-e more in need of insurance than are those who
are more fortunate.
Germany adopted health insurance in 188.3. Since then
it has been adopted by Austria, Hungary, Russia, Holland,
Norway, Great Britain, and other countries.
Various organizations throughout the country are giv-
ing earnest consideration to health insurance, and the
outlook for its being enacted into law seems excellent.
The American Bledical Association has taken up the ques-
tion, and will undoubtedly be active in protecting the
interests of physicians. The medical societies of Wiscon-
sin and Pennsylvania have endorsed its principles. The
American Academy of Medicine, the New York Cham-
ber of Commerce, the American Public Health Associa-
tion, the International Conference of Charities and Cor-
rection, the National Association of Industrial Accident
Boards, and seven state legislatures have appointed -com-
mittees to study and report upon health insurance. The
Federal Commission on Industrial Relations and the In-
ternational Association of Manufacturers are on record
as favoring it. Contrary to what might be expected,
however, there is some opposition to health insurance on
the part of the labor unions.
The standard bill drafted by the American Association
for Labor Legislation provides for a system of compulsory
health insurance. It makes health insurance obligatory
for all persons engaged in manual labor, and all other
employed persons earning $1200 a year or less. The
self-employed, whose earnings do not exceed $100 a
month, may insure themselves voluntarily.
Every fund or society must provide for its insured mem-
bers the following minimum benefits; medical, surgical,
dental, and nursing attendance and treatment; medicines
and medical and surgical supplies; sickness benefit equal
to two-thirds of the weekly wage of the insured person;
maternity and funeral benefits; also medical, surgical, and
nursing attendance, and supplies for dependent members
of insured's family. The funds or societies will be re-
quired to make arrangements for medical and surgical
attendance by means of panels of physicians, to which
all legally qualified physicians, hospitals and dispensaries
shall have the right to belong, and from whom the patient
shall have the right to choose.
HOW HEALTH INSURANCE MIGHT BE ADMINISTERED
The cost of the insurance will be assessed two-fifths to
the employer, two-fifths to the employee, and one-fifth
to the state. To the employer, this would mean about
1.5 per cent of his payroll; to the employee 1.5 per cent
of his wages, and to the state 0.75 per cent of the pay-
roll. Benefits would begin on the first day of illness, and
continue, if necessary, through twenty-six weeks in any
one year. Each panel would be administered by a board
of directors elected jointly by employers and employees.
In addition, there would be a committee in charge of the
funds, and a medical committee elected by the attending
staffs of local hospitals and panel physicians.
Health insurance will have a marked effect on hos-
pitals and dispensaries. Lender a system, such as is pro-
vided for in the standard bill, a large percentage of hos-
pital and dispensary patients, workmen and their de-
pendents, would automatically become pay patients. At
the New York Hospital it was found that 79 per cent of
ward patients and 95 per cent of dispensary patients
would come under the provisions of the bill. As this
hospital is located in an industrial district, the probabil-
ities are that these percentages are somewhat higher
than would obtain in hospitals generally. They are,
however, very suggestive and would seem to indicate
great changes in hospital relationships if the bill is en-
acted into law.
It is provided that the local fund authorities may make
arrangements with existing hospitals to care for their
patients, or that they may maintain hospitals of their
own. The increased demand for hospital accommodations
will result in the expansion of existing hospitals and the
construction of new ones. It is to be hoped that the tend-
ency will be largely toward the development of present
institutions rather than the creation of new ones. In the
past w^e have built more hospitals than we could adequate-
ly support; it is now coming to be generally recognized
that the interests of the community are served better by
a small number of well-supported hospitals, than by a
large number of impoverished ones. It seems fairly safe
to predict that the local fund authorities will not ordi-
narily care to assume the expense of erecting and main-
taining hospitals, but will, for prudential reasons, depend
on existing institutions.
The increased demand for hospital accommodations
will be due largely to the fact that sick workmen will
not delay so long before calling in a physician or ap-
plying to a hospital. It has been asserted that the aver-
age workman has not a single week's wages saved for
the proverbial rainy day; consequently losing moi-e than
a few days' time is a serious matter for him. Frequently
it means dependency for himself and family, and he does
not as a rule surrender to sickness until he is actually
compelled to do so. When he is furnished protection by
means of health insurance, his condition will be different
and he will not hesitate to go on the sick list, and de-
mand early medical and hospital care. This is borne
out by German statistics, which show that the morbidity
rate has increased under health insurance. It is interest-
ing to note that, while the morbidity rate has increased
under health insurance, the mortality rate has decreased.
This would appear to justify the assumption that the early
treatment of disease reduces the death rate.
Again, it seems safe to assume that the authorities
of the local funds will encourage their insured to apply
early for treatment. They will try to conserve their
funds by sending their insured to hospitals early while
there is still hope for speedy restoration to health, in-
stead of waiting until the disease has become chronic
or incurable.
As hospitals will be paid for caring for health insur-
ance patients, and as this class constitutes a large per-
centage of patients treated, health insurance should make
their support much easier than at present. Hospitals
which now treat largely free patients will be the most
benefited by health insurance, and, conversely, those which
treat largely pay patients will be the least benefited.
HEALTH INSURANCE WILL NOT INJURE PHYSICIANS
It is clearly the duty of hospital authorities to watch
carefully all health insurance legislation inti-oduced into
the various legislatures and to insist that the interests
of institutions shall be properly safeguarded. It is much
more satisfactory to enact the right kind of a law in the
416
THE MODERN HOSPITAL
beginning than to depend on subsequent amendments.
One of the great defects of the English law is that it
makes no provision for hospital care. It provides only
for such treatment as can be properly undei-taken by
the general practitioner. Accordingly, hospitals and spe-
cialists have no legal pi-otection and are worse off than
they were under the old conditions. The general practi-
tioner takes care of the routine work and sends the diffi-
cult and obscure patients to hospitals; and although he
is paid for his work, the hospitals receive little or noth-
ing for theirs. We must avoid blunders of this kind.
Not only will the financial status of hospitals be
changed, but the character of the work they are called
upon to do will be different. The change will be partic-
ularly noticeable in out-patient departments. The insur-
ance, or panel, physicians will take care of much of the
work which now falls to dispensaries. They will treat
such patients as are now ordinarily treated by general
practitioners. When the case is one that requires special
treatment or any attention which the panel physician is
not qualified to furnish, the panel physician, the officers
or directors of the funds are authorized to refer the
patient to a specialist, or a diagnostic clinic, a hospital
or a dispensary, as the nature of the case demands. In
this way, difficult or obscure cases will come to the hos-
pitals or dispensaries for consultant's opinion, for diag-
nosis, or for therapeusis.
The hospitals and dispensaries, being largely relieved
of the care of routine cases, will be enabled to develop
group medicine. The dispensaries will be given over
largely to specialists and will develop into scientific diag-
nostic clinics. This will be a distinct improvement over
present practice. It will accelerate the development of
scientific medicine and will benefit the patient, who will
be able to command the services of more skillful doctors.
The number of cases treated in the dispensaries will
undoubtedly be greatly decreased. Even under the un-
satisfactory English law, the decrease has been about
20 per cent. With fewer patients to care for, the doc-
tors will be in position to devote more attention to each
patient. As hospitals and dispensai-ies will be paid for
their services, they will have to provide remuneration
for their staffs, just as some now do in compensation
cases. In the case of ward patients, this will be a sim-
ple matter. The hospHal will be paid for the board
and care of the patient and the medical fee will go to
the physician. In the out-patient department, the division
of the receipts will be a little more complex, but an
equitable adjustment should not be difficult. It has been
stated that free dispensaries will cease to exist, but
this is only partly true, as undoubtedly there will still
be indigent patients, who will not come under the pro-
visions of the insurance law. and who will have to be
provided for, just as at present.
Physiotherapy as War Work for Young Women
The Surgeon General's Office, War Department, has is-
sued an urgent call for young women to serve in recon-
struction hospitals at home and abroad. The Normal
School of Physical Education, Battle Creek, Michigan,
which is affiliated with the Battle Creek Sanitarium, wish-
ing to do its share toward winning the war, has inaugu-
rated a course in physiotherapy, which meets the require-
ments of the War Department. Courses begin October 1
and February I. The length of the course is four months.
The curriculum consists of anatomy, physiology, hygiene,
bandaging, active and passive movements, hydrotherapy,
massage, electrotherapy, and clinics. Frank J. Born,
M. D., is the director of the school.
THE WAR:
ITS HOSPITAL, MEDICAL
AND NURSING ASPECTS
THE BLUE TRIANGLE HUT
How the Y. W. C. A. Gives War Nurses Comfort, Cheer,
and a Breath of Home — Blue Triangle Demanded by
Base Hospitals
Bv CLARICE NISSLEY. Special Writer for United War Work
Publicity Campaign Department, Chicago.
The youngest nurse at Base Hospital No. 10 slipped
back very softly to the bed of the youngest private.
He was so obviously the youngest private. Ten
days before he had thought he was "going west," he had
laboringly told her the lie that was bothering him.
"I told 'em I was eighteen and I'm not. I'm only six-
teen," he had whispered in breaths that were very short.
He had enlisted as a musician and had gone out with his
regiment, playing. But in the thick of it he had dropped
his cornet and had snatched the gun which the boy ahead
was letting slip. Then he had gone on with the rest and
the stretcher bearers had brought him in. "This war's
no place for a musician," he had tried to smile.
He was sleeping just as the nurse had left him. His
hair, rumpled where the bandage crossed his forehead,
was moist and curling. On the white tray by his cot the
nui-se unrolled the napkin from the dish she was carrying.
It was her own dessert. She left it where the youngest
private would see it and again tiptoed out of the ward.
Out in the compound the youngest nurse, with thirty
minutes left from her dinner hour, hesitated. Anxious
thoughts kept jumping back into her head, worries about
the youngest private, about the white-headed boy lying on
Fie. 1. Exterior oi! the Y. W. C.
young women, Camp Sherms
. residence for nurses and employed
Community, Chillicothe, Ohio.
the cot next to him, and the lad who had been brought in
the night before with the wound that wouldn't stop bleed-
ing. She wanted desperately to forget them for these
thirty minutes. From the Blue Triangle hut at the edge
of the compound came the sound of a victrola and she
started toward it.
Dropped down by the side of row after row of hospital
barracks, long barracks, inside whose walls eight thou-
sand beds stretched up and down the corridors, the hut
THE MODERN HOSPITAL
417
looked no larger than an infantry's pup tent. It was an
unstained pine building and on its doorpost was the bright
blue triangle of the Young Women's Christian Associa-
tion.
Sixteen Blue Triangle huts at base hospitals of the
American army in France are supplying comforts for the
American nurses in their few hours off duty. Frequently
the one-room building is the only attractive place on the
barracks compound. The rooms in which the nurses sleep
are little different from the wards in which they work.
Often mornings during the past winter their boots would
be stiff and their washcloths frozen to the water pitcher.
After the first few months, in which they waited as the
American army itself was waiting, hearing of battles on
the French and British fronts, but they themselves caring
for only a few cases of mumps or measles, they were
swept into the night-and-day rush of the offensives. Dur-
ing both the tedium of the waiting and the weariness
of constant duty, the Y. W. C. A. furnished to the nurses
a place for rest and recreation.
At night, when the nurses come off duty, a Y. W. C. A.
secretary at the Blue Triangle hut is waiting to give them
a cup of hot chocolate. Hot tea and wafers are ready for
them at any time during the day. There are magazines
and books, often a victrola, comfortable chairs into which
they may drop for just a few minutes' rest, and, best of
all, conversation and laughter that has nothing at all to
do with sickness.
In some cases the club rooms are part of a building de-
signed to house both the Y. M. C. A. and the Y. W. C. A.
work. In others the nurses' center is a separate building.
■In one city an old bar room of a hotel which before the
war was famous for its sporting crowds was the only
place available for the Blue Triangle room, but it is now
a cozy sitting room. A few rugs and chairs, pictures
and war posters, dishes of Breton ware bought at the
little French shops, have made the difference.
"This village is a well-known watering place," writes
Miss Marion E. Porter, the Blue Triangle secretary at
Base Hospitals No. 2-3 and 36. "It is far up in the foot-
hills of the French mountains and is quite famous for its
wonderful spring water. We have golf links, polo grounds
and eight tennis courts.
"In the summer we expect to use the race course as a
baseball ground, and this is surrounded by a lovely park
with benches, shady walks, a lake and several springs.
The scenery in the vicinity of this village is magnificent,
and as soon as the weather is warmer we shall take long
walks and combine exercise and pleasure in visiting some
of the neighboring villages to see the lace makers; this
spot is the greatest lace center in France."
Near the Blue Triangle foyer are tennis courts where
the nurses can play when they are not too tired. On Sun-
days groups of girls relieved of duty start off with the
secretary for an all-day tramp and a picnic. French
classes are well attended at all the centers, lectures and
entertainments are regularly provided, and on Sundays
there are vespers and Bible classes. Change of thought
and vigorous, outdoor exercise for every nurse, in spite
of Gei-man offensives, air raids, or a daily inrush of
6/essc.s, is the task which the Young Women's Christian
.Association has undertaken. Occasionally there is a
party, a birthday celebration for some nurse or doctor, for
which the Blue Triangle secretary saves sugar for weeks
ahead and brings it forth the final evening as the big sur-
prise. It may be that the party, just nicely started, is
suddenly inten'upted with the command, "Prepare for
patients," but even tliough the nurses hurry from the
Blue Triangle hut to the operating room, partyless, they
have had the pleasure and stimulation of making the
plans.
"I feel as though I had been running a Blue Triangle
hotel rather than a hut for nurses during the past month,"
Miss Willie Young of Charlotte, N. C, wrote from one
base hospital, "for Base has been used as a starting
point for the extreme front for our numerous teams of
nurses and doctors and then a gathering point for them
on their way to their base, and in between these regular
operating teams there has been that steady sprinkling
of "casuals," wandering, disconnected souls of the A. E. F.
who have no base or goal or resting place of any kind.
They stay a few days and then, like Poor Joe, keep a mov-
in' on. They can receive no mail while they are in France,
as they can never be located, so their road is an isolated
one in the midst of crowds.
"During all the moving our original one hundred and
thii-ty-five nurses are sticking to their tense task with
hardly an hour off in the day. Stone floors in the wards
make their feet ache after hours of standing and the ex-
treme suffering of plucky boys from this last victorious
drive simply takes the life out of one. The hut stands to
them as a glimpse of the normal, the outside, and a breath
of home. It is so close to the wards that if the nurses
have ten minutes off they can run over, drop in a chair,
and just sit and be quiet."
One hundred and eleven women are now in France
working for the Y. W. C. A. Besides its nurses' huts,
the American organization is operating hotels for the
American women in Paris and the girls of the United
States Signal Corps, and Blue Triangle foyers for the
girls of the munition plants. There are now fifteen Y. W.
C. A. Foyers des AUiees where French girls are provided
with entertainment, reading matter, and a comfortable
clubroom in which to rest. As rapidly as possible the
work with both the French and American women is being
extended. Already requests for Blue Triangle huts have
come in from six additional base hospitals and others will
follow with the arrival of more hospital units overseas.
They will be met as quickly as funds and workers are
available.
American Nurses' Club in London
To meet the need of American nurses in France the
London Chapter of the American Red Cross has founded
the American Nurses' Club at 42 Grosvenor Place, Lon-
don. This is intended to be the nurses' headquarters in
England.
The Countess of Granard, formerly Miss Beatrice Wil-
ley, New York, has given up a floor of Forbes House to
start an annex to the nurses' club. Bedrooms are avail-
able for the use of members at the nominal charge of
418
THE MODERN HOSPITAL
half a dollar a night; theater tickets are often put at the
disposal of members and the committee in charge ar-
ranges for drives and excursions through London. The
committee is as follows: Viscountess Harcouvt, chair-
man; Mrs. Carnegie, Mrs. R. W. Chaplin, Mrs. Craig-
McKerrow, Adele, countess of Essex; Mrs. E. B. Lane,
Mrs. Powell, Mrs. Tobey and Mrs. Delany. The club is
financed by the American Red Cross.
WORK OF THE AMERICAN WOMEN'S HOSPITALS
IN FRANCE
Second Unit Sails — First Military Hospital Established by
American Medical Women in France — Personnel
of Unit
The second unit of the American Women's Hospitals
has just sailed for France. This group will be added to
the staff of the military hospital directed by Dr. Barbara
Hunt which, in cooperation with the American Committee
for Devastated France, is working with the Sixth Army
Corps. The hospital will contain one hundred military
beds, with capacity for expansion to meet the utmost
needs of the Sixth Army, and a small civilian ward. The
group consists of: Dr. Caroline M. Purnell, Philadelphia;
Dr. Mary L. Evans, Middletown, Conn.; Dr. Charlotte
Fairbanks, St. Johnbury, Vt.; Dr. M. Ethel Fraser, Den-
ver; Dr. Mary McLachlan, Portland, Ore.; Dr. ler Jay
Manwaring, Norwich, Conn.; Miss Mary MacCully, Phila-
delphia; Miss Julia C. MacAlister, Philadelphia; Miss
Agnes MacLatchie, Philadelphia; Miss Margaret B. Pur-
vis, Atlantic Highlands, N. J.; Miss Florence Chapmen,
Montville, Conn.; Miss Wilhelmina Drummond, Atlanta,
Ga. This is the first military hospital established by
American medical women in France.
Dr. Hunt sailed early in June with two other members
of her staff. The hospital completely equipped was estab-
lished in a chateau at Neufmoutiers, August 1. This hos-
pital included fifty military beds, but it had hardly been
established before Dr. Hunt was asked to increase it to
one hundred military beds and to go nearer the front.
This has been done and the hospital is working near the
base of the Sixth Army.
With the second unit has sailed Dr. Caroline M. Pur-
nell, special commissioner for the American Women's Hos-
pitals in France. Her mission will be to inspect this
military hospital, to consult with the French medical
authorities, and the American Red Cross in Paris and to
survey the field generally. She will also discuss with the
chief surgeon having the matter in charge the establish-
ment of a mobile gas hospital which the American
Women's Hospitals under the advice of the French mili-
tary authorities are establishing for the French army.
Miss Jean Pattison, a third-year medical student at
Cornell, has spent her vacation as a volunteer worker in
France, and since July has been on the staff of Dr.
Barbara Hunt. When Dr. Hunt was asked by the French
authorities to go to Meaux to help in an emergency. Miss
Pattison went with her. For her work at Chateau Thierry
with the American troops she received special commenda-
tion. The following letter gives a description of some of
her experiences there:
"Dr. Hunt was just going to Paris on Sunday, July 22,
when she received word that the French hospital at Meaux
needed help. She and Miss Pettingell, Miss Merrick and
I went at once by motor and got there about seven. The
hospital medecin chef told us to report at eight in the
morning. When we went into the triage chirurf/ical that
morning we saw a large room with six surgical tables and
blesses everywhere — on stretchers or sitting up waiting
their turn. The men came in from the field and went
first to the main triage where les dames anglaises gave
them cofi"ee and lemonade and they were given their bil-
lets and sent over to the triage chirurgical. Five of the
tables were in charge of French doctors with a nurse
and orderly for each — the sixth was given to us. The
brancanUers brought the blesses to us, and as soon as
we finished with one another took his place. We alter-
nated, Dr. Hunt and Miss Pettingell with Miss Merrick
and myself and worked eighteen hours one day and thir-
teen the next, so that we were on duty only over night.
The poilu is the most wonderful patient I can imagine —
quiet and plucky and yet so utterly weary. During the
first few days we had a thousand a day, but as the of-
fensive moved west we got less and less. Poilus would
walk in when it seemed impossible they could even move.
One of my patients walked thirty kilometers with a brok-
en arm and scalp wound. Some of them would get so ex-
cited telling about the battle that they would scarcely
stay on the table. Comparatively few had only one
wound. 'The orderlies were poilus and my particular one
was a most grubby little one, but after I had worked with
him a day I knew I could never live happily again with-
out him. They were so quiet and gentle with their wound-
ed comrades and in the ten days we were there I never
heard one get cross or impatient.
"After we had cut off the soiled clothing and examined
and dressed the wounds we wrote the diagnosis on the
outside of an envelope and directed whether they could be
evacuated at once to Paris by boat or train, or, if they
were fractures of the skull or leg or penetrating wounds,
which hospital they were to go to.
"Some of the men came in with paper bandages on their
wounds. They were taken from the boche, an orderly
told me.
"The people at home who are making surgical dressings
ought to know how their work is appreciated over here.
At Meaux there were plenty and it was the greatest help
in the world. Les dames anglaises had pajamas too and
these were a great comfort. The French do not use the
lower part and when an American girl put them on a
poilu in the triage one day the doctors and orderlies all
came to see him and one remarked — 'The Americans, so
droll : They would make tennis players out of a poilu.'
"After five or six days things quieted down and Dr.
Hunt and Miss Pettingell went back to the chateau, and
Miss Merrick and I stayed for five days more. Then we
were sent a telegram saying that the American hospital
at Chateau Thierry needed help and to go by the first
train. No trains were going through, but Captain Dore-
glas of the United States Ai-my sent us over in one of
his cars. It was a wonderful ride through the valley of
the Marne with the trenches running through the ripe
wheat field. It seemed impossible that that ground could
have been fought over within the past week. It doesn't
seem possible, but the grain isn't even tramped down. In
some of the boche huts in the trenches we saw quilts and
mattresses that they had taken from the villages near by.
They lived comfortably but not long in those trenches.
As we got further along many of the houses were com-
pletely destroyed. We got to the hospital and went on
duty at once. The hospital was an old French one, but
had been used by the boche so nothing was left there.
The offensive had gone forward quickly and the wounded
poured in so fast that we all had to do with what we had
at hand, but it was terribly inadequate. Miss Merrick
went to one postopei'ative ward and I to another and did
everything we could to make the boys comfortable. All
the water had to be carried some blocks and of course
we had no heat nor light except solid alcohol and candles.
There were plenty of blankets and that was the greatest
comfort. The boys who were dying were awfully glad
to have an American with them and their dying was not
that of a worn-out invalid — they were strong and wanted
to live.
"The boys who worked as orderlies were fine." I'll never
forget one boy who was scrubbing dishes over a tin alco-
hol. I told him he'd be a candidate for Delmonicos when
he got home and he grinned as he said, 'Not much, but
gee, I can't help thinking what a help I'll be around the
house after this.'
"After a few days a train came in and most of the
cases were evacuated to a base hospital. The abdominal
and the shock cases had to stay. One little Irishman in
the shock ward asked me if I was his mother and I told
him I was. After a little while he said, 'Are you my
sister?' 'Yes, of course, I am,' I answered. The next
time he wakened I went down and he said, 'Ah, you are
THE MODERN HOSPITAL
419
the Blessed Virgin, I knew you would come.' Just then
Miss Grant came in and looking over at her he said, 'No,
there is the Blessed Virgin. Will she go with me?' I
told him reverently she would and he died quite happy.
"The Knights of Columbus and Y. M. C. A. brought the
boys chocolate and cigarettes and they did appreciate
them.
"Finally all left the hospital and we came back
again to Neufmontiers. The aspect of the chateau had
changed, and we found a hospital in its place with beds
covered with gay blue spreads with an operating room
ready and Dr. Hunt and the nurses more than ready for
the patients. In a few days these began to arrive, old
men and women and children undernourished and over-
worked. It is surprising how quickly they respond to
rest, good food and good nursing. We all feel that the
hospital has started in a short time considering all the
unavoidable delay, and each day we see things going
ahead and going ahead well."
WAR WORK OF SEVEN ORGANIZATIONS
Cooperation of Young Men's Christian Association, Young
Women's Christian Association, National Catholic
War Council, Jewish Welfare Board, War Camp
Committee Service, American Library Asso-
ciation and Salvation Army
Seven organizations with the single purpose of doing
their bit toward winning the war by helping to keep the
military and industrial armies fit, are cooperating in a
war drive beginning November 18, to raise $170,500,000
for their war work at home and overseas. Each one of
the seven has answered an imperative call. Each one is
filling a definite war-time need. They all are chiefly con-
cerned with the physical needs and the moi'ale of the
army. All have been engaged, since the beginning of the
war, in service which has been recognized not only as "the
greatest recorded demonstration of practical Christian-
ity," but as a definite asset in the efficiency of the allied
armies.
The Young Men's Christian Association, which is ask-
ing $100,000,000 for its war work, is serving over three
million soldiers and sailors in Europe and in the training
camps of America. It is keeping a bit of home in the
trenches and under the very fire of the enemy. The Y.
M. C. A. hut at the front is the soldier's club, his church
and his college, a place of entertainment, recreation, rest
and study, and the quiet spot where he is provided with
facilities for writing letters home. It is open to all creeds
for service, from the early mass of the Roman Catholic
to the later service of the Protestant clergyman and
Jewish rabbi, and the song service held by the Salvation
' Army.
The Y. W. C. A., asking $15,000,000, has gone into the
war and war industries in behalf of the welfare of women
and girls called to new and perilous work. It has pro-
vided proper housing and care, as well as recreation cen-
ters, not only for the munition makers of this country,
but also for those of France, and its efforts have met with
such marked success that the English government has
asked its help in work of this character in that country.
Already about one hundred hostess houses — "a bit of
home within the camp" — have been erected at military
camps at the requests of commanders, and a number are
authorized and being built. It is also doing extensive
work among the colored girls and foreign-born.
The National Catholic War Council, including the
Knights of Columbus, asks $30,000,000 to carry on its
work. The Knights of Columbus have erected club-
houses at all the points of embarkation in this country
and in France, as well as at the camps in America and
"over there," where wholesome recreation is furnished and
a cheerful welcome awaits soldiers of all creeds. It has
secretaries assigned to permanent duty aboard transports
plying between this country and European ports, and one
hundred K. of C. secretaries have just been ordered to
Italy, where ten new buildings are being erected. A head-
quarters building is maintained in Paris and permanent
clubhouses throughout London and France. A fleet of
motor trucks, carrying cigarettes, tobacco, chocolate, writ-
ing material, soap and towels, and other articles, follows
the rapidly advancing armies to provide our boys with
"service under fire."
The Jewish Welfare Board, which will receive a $3,500,-
000 share in the campaign, officially represents all na-
tional Jewish organizations in building up the morale of
over one hundred thousand Jewish soldiers and sailors.
It has erected clubrooms for soldiers, irrespective of race,
supplied them with libraries of English, Yiddish and He-
brew volumes, and manned them with trained workers.
Social rooms and sleeping quarters are maintained in
camp towns. Jewish chaplains are serving everj'where
in army work, and religious services are open to all.
Welfare workers aid the families of soldiers and keep the
boys at the front in touch with the homes they have left
behind.
The Library War Service of the American Library As-
sociation, which asks $3,500,000, has sent overseas during
the past year more than a million books for the boys of
our fighting forces. With quick, direct and loyal service,
it supplies books for pleasure and for study. In all huts
and canteens, the branch library offers the soldier or
sailor recreation for his hour off duty in the form of
suitable novel or magazine. In every ward of every mili-
tary hospital, the book shelf is at the hand of the con-
valescent soldier. On every transport a deck library is at
the sei'vice of the boy who would read. And each dollar
given by the public for this purpose will circulate through
the Association to the man in every branch of the ser-
vice.
The War Camp Community Service, asking $15,000,000,
is a nation-wide movement for hospitality, conducted
through a definite, well-ordered program, working in har-
mony with the training camp program of the War and
Navy Departments. For the soldier or sailor off duty in
a sti'ange town, it counteracts the red-light lure with the
greater attraction of wholesome recreation and thus
speeds the man in khaki or blue on his overseas way with
a keener enthusiasm to fight for a country in which he
leaves no bitter, regretful memories. In April, 1917, the
War Department Commission on Training Camp Activities
was appointed by Secretary Baker, and the Navy Depart-
ment Commission, by Secretary Daniels, and these com-
missions have cooperated with the Playground and Re-
creation Association of America, well experienced in this
type of endeavor, in carrying on the work in communities
outside of, and adjoining, camps, under the official name of
the War Camp Community Service.
The Salvation Army, calling for $3,500,000, carries its
relief work into the vei-y trenches and serves hot food to
the men under fire. Every Salvation Army "hutment"
has its cook stove and oven, and "lassies" with baskets
of food stand under fire to give a hot cup of coffee to the
men who are bringing up the ammunition. Truck loads
of pies and doughnuts are sent daily fi'om the bases to
the extreme ends of the lines, and women officers darn
and mend the clothing of the soldiers who come to the
hutme.i.s for recreation. In this country, hotels and club-
rooms furnish rest and entertainment near military and
naval bases, with the usual church services held on
Sundays.
420
THE MODERN HOSPITAL
Cleaning Operating Rooms After Septic Operations
To the Editor of The Modern Hospital:
Please give us your opinion as to the best method of
makin": a safe and practical sterilization of the operating
room after a septic operation.
An Alabama Hospital.
It has been very definitely decided by authorities on
the communicability of various diseases and pus organisms
that soap and water properly propelled by hand and
elbow power are the best disinfectants known, and that
their free use is the only safe and sure method of
sterilization for anj'thing that cannot be put in a sterilizer
and boiled.
Study, experience and laboratory tests have proved to
us that we must have less and less faith in fumigation and
disinfection as ordinarily practiced. Solutions of bichlorid,
cresol compounds, formaldehyd and other disinfectants
have little value unless the article to be disinfected can be
immersed in them and left there for a definite length of
time. This would hardly be possible to do with operating
room tables or operating room floors and the casual
wiping them off with these solutions is surely not disin-
fection.
When operating in an infected case it should be the duty
of your operating supervisor and her nurses to see that
the infected material is confined to the smallest possible
area, and as soon as the operation is finished that this
material is removed and isolated as soon as possible.
Everj'thing that can be should be subjected to live steam
or boiled.
Floors, tables, and standards should be thoroughly
washed with water and plenty of strong soap. Your
operating room attendant should be provided with gloves
for this work.
Sanitary Toilet Seats
To the Editor of The Modern Hospital:
In planning the new additions to our buildings, consid-
erable doubt has arisen in our minds as to the various
kinds of bathroom furnishings advised and advertised.
Would you care to give us your opinion as to the best
and most sanitary type of closet seats?
Of course those which seem to be the best are also the
most expensive. Is it really worth while to put so much
money into that sort of fixtures?
Chairman of Building Committee.
The most satisfactory type of seats are those made of
white enameled steel or porcelain or those made of hard
rubber products and having the least exposed metal.
Wooden seats may be produced and sold for less money,
but can not be as sanitary and they require a constant
cost of revarnishing in their upkeep. There can be
very little doubt that these fixtures which are made of
better material are more economical in the long run and
certainly a better means of protection from infections
to your patients and employees.
"Don't be penny wise and pound foolish," applies to
the building of a hospital as to a home or hotel.
Cubic Feet Per Patient in Isolation Hospital
To the Editor of The Modern Hospital:
Will you kindly give me your opinion as to the number
of cubic feet and square feet per patient required in a
ward of an isolation hospital?
As several authorities consulted have varied opmions
in regard to this matter, I will appreciate very much
vour valued advice.
A University Health Officer.
The reason you have had so many opinions on the
subject is that each opinion is predicted on a different
condition of affairs; for instance, it will require much
greater spacing of patients where the windows are small
and the ventilation poor, and not nearly so many patients
can be put into a given area under those circumstances.
In some of our newer isolation hospitals, where the win-
dows are large and are opposite each other, so that there
can be fresh air playing across the rooms all the time,
you can readily understand that a great many patients
could safely occupy a given area.
Taking the average window space, height of ceilings
and the usual number of door openings, with an average
outlook as to the free circulation of air from the outside,
80 square feet or 800 cubic feet would be a most liberal
allowance. If the circulation of air is good through the
ward or room, half that much space would be ample.
So you can see that your various opinions might all
of them have been correct, each from its own standpoint.
Painting Hospital Wards
To the Editor of The Modern Hcspital:
We are contemplating painting our wards and have in
mind a French bedroom gray for the ■yvalls and ceiling,
with white woodwork. I am puzzled as to whether the
walls should be flat or enamel. I feel that the enamel
may be more easily cleaned, but am somewhat puzzled as
to the effect of the gloss. The wards ai-e well lighted.
Have you any suggestions to offer as to color and the
paint?
A Superintendent of A State Hospital in the East.
French bedroom gray is considered a very good color
for walls and ceiling. We would advise flat finish instead
of enamel. After the paint is well seasoned, a coat of
starch is advisable. It should be prepared as follows:
Take three large teacupfuls of thick boiling cornstarch
and dissolve in half a pailful of cold water, stir thoroughly
and boil. After it has boiled, strain it through a sieve
and thin down to about one pailful. This should be put
on the wall with a calcimine brush. Starching the walls
preserves the paint; and when it is necessary to wash the
walls the starch comes off with the dirt and leaves the
paint fresh and new. After being washed, it should be
starched again.
The following notice has been posted in every room or
every department of Presbyterian Hospital, Chicago:
Save 1,000,000 Lives
Jyff^- HOOl'^ER tells us that if we economize in use of all
food stuffs and avoid waste in all materials, we can shorten
the war one year and save one million lives. Here is war work
for each of us. I urge most careful thought and assistance on
the part of everyone.
Nothing Too Small to Save
Save Everywhere Save Everything
and by so doing, help
Save 1,000,000 Lives
.ALBERT M. DAY. President.
THE MODERN HOSPITAL
421
NEW
INSTRUMENTS
AND EQUIPMENT
VINCENZ MUELLER. Techni(
GEO.W-WALLERICH. Assoc!
>1 Edito
teEdilo
Please address i
ments and Applian
avenue. Oak Park,
Gauze-Rolling and Folding Machine
For the purpose of expediting the work of preparing
surgical dressings, as well as economizing in the use of
gauze, Miss Maud D. Woodward, R. N., of the Danville
General Hospital, Danville, Va., has devised a simple and
inexpensive gauze-rolling and folding machine.
The table on which the device is built is about 29 inches
long, 16 inches wide and 46 inches high from floor to
top of roller. The roller is 10 inches in length, 12 inches
in diameter, and the circumference is 36 inches. The
Woodward gauze-rolling and folding machine.
gauze is placed on the roller below and is then divided
by means of a rod which is situated on the under side of
the table. This rod divides the gauze into 9-inch widths.
The end of the gauze is fastened to the reel by means of
three sharp pegs which hold it securely in place. The
reel is divided so there are grooves 2 inches apart, which
permit of cutting the dressings from 2 inches to 36
inches in length.
With this machine it is possible to cut 100 yards of
gauze into 600 dressings 9 by 6 inches in fifteen minutes,
while the same number will take about one hour's time if
the work is done by hand. Thus it will be seen that this
-simple machine will be a great time saver. Likewise con-
siderable economy in the use of gauze is effected.
A New Blood Counting Apparatus
Prompted by the numerous well-founded complaints in
regard to the counting chambers' becoming loose in the
cement and thereby exposing the user to considerable re-
pair expenses, experiments were started by Mr. A. Trae-
ger, of E. Leitz Company, New York, to construct a
counting chamber of which the supporting surfaces for
the cover glass and the slide itself are combined in the
one piece in order to eliminate the cemented cell.
The new instrument, which is called the "Elei" blood
counting apparatus, seems to have solved the problem in
a most satisfactory manner, inasmuch as in this model
the glass benches supporting the cover glass are a part
of the glass slide, thus avoiding entirely the cementing
chamber.
The "Elei" counting apparatus follows the parallel type
of chamber as originally suggested by Dr. Buerker, which
provides for a rectangular disc of glass with ruling, the
disc extending entirely across the slide between the two
Counting chamber and diluting pipette.
parallel glass benches. Such a construction is said to
prove a distinct advantage over the original "Thoma"
model, which favors the circular disc, mounted in the
center of a round chamber, cemented to the slide.
The manufacturers claim that the "Elei" counting
chamber, parallel form, provides a more uniform distribu-
tion of the blood corpuscles than is obtained with the cir-
cular pattern, of which the chamber is entirely closed by
the cover glass. Dr. Buerker has proved that atmos-
pheric pressure does not effect the open and parallel
chamber and consequently does not alter the actual depth
of the solution film when counting blood corpuscles.
With the new counting chamber, when the cover glass
is placed in position, the ruled rectangular disc remains
0.1 mm. beneath the lower surface of the cover glass.
This construction allows the hollow space between the
ruled surface and the cover glass to be filled by capillary
attraction, after the cover t/lans is in position. By this
method, the chamber is filled when touching the rectangu-
lar ruled disc under either edge of the cover glass with
the tip of the filled diluting pipette. The glass benches
for the support of the cover glass are elevated above the
level of the slide and thereby permit the cover glass to
be attached and also removed easily.
Tlie manufacturers state that the construction of the
"Elei" counting chamber closely observes the specifica-
tions of the U. S. Bureau of Standards. The tolerance of
error, established by the bureau on May 1, 1917, is as
follows: For the counting chamber — error of length of
side of the large square not to exceed plus or minus 1
per ctTit, plus or minus 0.01 mm.; error in depth of cham-
ber not to exceed plus or minus 2 per cent, plus or minus
0.002 mm.; for the diluting pipettes — error not to exceed
3 per cent in the principal interval.
422
THE MODERN HOSPITAL
Electrothermal Applicators
A device called the "electrothermal dilator" is shown
in detail in the accompanying illustration. The name
implies that the purpose of the instrument is to apply
electricity to certain parts of the body, but this is not a
fact. It is used for the purpose of applying heat in
the treatment of hemorrhoids, rectal fistula and rectal
prolapsus, etc., and is so constructed that it is absolutely
impossible for the patient to receive an electric shock.
The instrument on insertion produces a gentle dilatation
of the rectum, and, after connection to the electric cur-
rent, a continuous supply of heat is applied to the dis-
tressed organ. The heat rises gradually and can be
maintained and regulated at any temperature that may
be desirable in each individual case.
The body of the dilator is made of a hard, highly
polished material which can be thoroughly sterilized with-
out danger of injury. The diameter of the dilator is
about three-fourths of an inch.
The heating system is constructed from a lasting alloy
of nickel wire and sealed within the body of the dilator.
the temperature required in any case. The reniform
shape and its small size make this pad extremely use-
ful for the purpose for which it is designed, as it fits
nicely behind the ear, and it will be readily seen that
The controller (with an "on" and "off" button of different
colors) is inserted into a heavily insulated conducting cord
about 4 feet from the dilator, the entire cord being 10
feet in length. The connecting plug is inserted into a
serris plug which is furnished with the outfit, for the
purpose of lowering the voltage of the street current to
the required degree.
Where the commercial current is not available, five dry
cells properly connected may be used, for which pur-
pose cord tips are attached to the conducting cable in-
stead of the attachment plug.
Urethral catheters or bougies of different sizes for
application of heat can also be furnished, and these are
so arranged that they can be attached in the same man-
ner as the dilator.
Electric Pad for Applying Heat to the Eye and the
Mastoid Region
The Goodwill electric heating pad was described in a
former issue of this journal. Since then this pad has
proved so satisfactory that I have asked the manufac-
turers to construct a small pad on the same principles as
the large one, but of a size and shape that could be used
for applying heat to the mastoid region and the eyes
and the outfit illustrated here is the result.
The pad is equipped with the Goodwill resistance wound
thermostat, which permits of its being adjusted to exactly
Electric heatine: pad for the eye ami the mastni<i
it can also be used to apply heat to either one or both
eyes at the same time.
The pad operates in series with a 60-watt, 115-volt
lamp on any voltage from 100 to 125. The small lamp
.is shown in the cut is connected in multiple with the
pad. This has a tendency to limit the voltage in the
pad itself and, in conjunction with the Goodwill method of
sewing the heating element in place, makes the pad safe
from short-circuiting.
The outfit is furnished complete with the Benjamin
series plug, a large and small lamp, 12 feet of flexible
cord, and a washable cloth cover, as well as a rubber
Electric Spray Heater
Owing to the fact that in cold weather oily substances
incline to solidify and cannot be kept in perfect solution,
considerable difficulty has been experienced in using the
ordinary sprays for this purpose. Various spray heat-
ers have been devised in the past, but, as a rule, the heat
from an electric globe has been utilized, and this has
never proved quite satisfactory. With the heater illus-
trated here, the temperature may be regulated so that
the warm solution, which, as is well known, is more effi-
cient and comfortable, may be administered; and it can
even be brought to a boiling point if sterilization is nec-
essary.
The center glass can be used for the purpose of melt-
ing wax or paraffin, or for the sterilization of laryngeal
mirrors, etc.
The illustration shows cords with terminals for attach-
ing to a parallel socket, but, if desired, it can be furnished
with regular attachment plug for connecting to ordinary
light socket. The device works on either direct or alter-
nating current of 110 volt.
«u|jiii|iiiiii|iMiimi
m^
SCTgSgX'Jg^
rr~tif
'^■'^^■^Si^^^
THE MODERN HOSPITAL
A Monthly Jouma/ Devoted to the Building, Equipment, and
Admmistration of Hospitals, Sanatorinnis, a^id Allied Institutions,
and to Their Medical, Surgical and Nursing Sei-vices
Vol. XI
December, 1918
No. 6
D^l^^^'^^'^^"^^^:^^^'^^^^''^^^^^^^^^^^
EPIDEMIC INFLUENZA AND THE U. S. PLBLIC HEALTH SERVICE
Magnitude of Task of Relief— Cooperation of State Public Health Officers, the American
Medical Association, the Volunteer Medical Service Corps, the Red Cross, the
Medical and Nursing Professions and the Public— Preventive
Measures — Important Research Undertaken
By RUPERT BLUE, Surgeon-General, United Spates Public Health Service, Washington, D. C.
IN sketching the activities carried on by the
United States Public Health Service in con-
nection with the recent epidemic of influenza, we
go back to the summer, when unconfirmed re-
ports reached this country that influenza was
prevalent in Europe in pandemic form. On August
16 a circular was addressed to all the United
States quarantine stations cautioning the medical
officers to be on the alert in the inspection of ves-
sels from European
ports so as to detect
any cases • of the so-
called "Spanish" in-
fluenza.
In this connection, it
may be well to point out
that maritime quaran-
tine measures are di-
re c t e d principally t o
guard against the in-
troduction into this
country of exotic epi-
demic diseases, such as
cholera, plague, yellow
fever, and typhus fever. It would be mani-
festly unwarranted to enforce strict quarantine
against diseases regularly quite prevalent in
this country, such as typhoid fever, scarlet
fever, measles, and the common respiratory dis-
eases, including influenza. In accordance with
these considerations and the fact that influenza is
not a quarantinable disease, the quarantine officers
were instructed, if such disease was discovered
on in-coming vessels, not to release such vessels
Fig. 1. Influenza hospital organized by the U. S. Public Health Serv
in Washington, in quarters furnished by the War Department.
from quarantine until after the local health au-
thorities had been notified and after steps had
been taken to prevent the spread of the disease
from such sick persons.
Soon after this, the disease made its appearance
in Boston and vicinity and in a short time spread
in virulent form throughout the state of Massa-
chusetts. Foci of the disease were also reported
from other parts of the country, especially along
the Atlantic seaboard.
In this situation it be-
came apparent that the
Public Health Service
would be called upon to
render assistance to
local and state health
authorities far beyond
the allowances of its
regular appropriation.
It became imperative,
therefore, to p r o v i d e
funds for emergency
needs, especially since
the epidemic threatened
to disorganize the entire system of war produc-
tion, munitions, mining, and ship-building, as
well as the mobilization of troops. Accordingly,
at the request of the Public Health Service, Con-
gress adopted a joint resolution granting $1,000,-
000 to the bureau for combating "Spanish" influ-
enza. The very prompt action of Congress was
as encouraging as it was gratifying, and the
funds thus provided enabled the Public Health
Service to enroll additional doctors and nurses
424
THE MODERN HOSPITAL
and send them in response to calls from stricken
communities.
In the further description of the activities of
the United States Public Health Service in dealing
with the epidemic it may be well to consider these
under two phases :
1. The provision of immediate relief for the
stricken communities.
2. The inauguration and proper organization
of measures for the relief and control of the epi-
demic in those parts of the country where the
disease had not yet appeared.
Although the relief measures loomed large in
the early days of the epidemic, the organization of
preventive and relief measures in the non-stricken
areas received a large share of attention from the
outset. In fact, the two phases of work were car-
ried on side by side.
RELIEF MEASURES
Some idea of the magnitude of the task con-
fronting the Public Health Service may be gained
from the fact that the requests for help from the
vicinity of Boston alone included one for five hun-
dred doctors, a number far in excess of those the
service had available for such duty. Moreover it
was clear, and subsequent events so showed, that,
with the spread of the epidemic, similar calls
would quickly come from other communities.
In response, therefore, to the urgent request for
medical and nursing relief, all available regular
officers of the Public Health Service were detailed
to the stricken communities. Added to these was
a force of trained nurses, temporai'ily detached
from trachoma and other public health activities
carried on by the Public Health Service.
Inasmuch as a large part of the country's med-
ical and nursing personnel had been enrolled with
the military forces, a request was addressed to the
Surgeons General of the Army and of the Navy
for a detail of doctors and nurses to aid the ci-
vilian authorities in providing emergency care in
stricken communities. Unfortunately, the de-
mands of the military population were themselves
so pressing, largely because of the widespread oc-
currence of influenza in the training camps, that
very little help could be obtained from this
quarter.
In this emergency the Public Health Service
called upon the American Medical Association, the
Volunteer Medical Service Corps, the Red Cross,
the medical and nursing professions as a whole,
and on the general public for personnel to help
combat the epidemic. In response to the request
for physicians available for duty in the Public
Health Service, the American Medical Association
and the Volunteer Medical Service Corps compiled
lists of a large number of physicians classified by
states. Appointments were ofi'ered by telegraph
to these physicians by the Public Health Service,
and within forty-eight hours groups of physicians
were on the way to some of the stricken communi-
ties in New England. Soon afterward, similar
medical units were sent to New Jersey, New
York, Pennsylvania, Delaware, Mississippi, Mon-
tana, South Carolina, Virginia, West Virginia,
Tennessee, and Arizona. In this connection, men-
tion may be made of the fact that the Maryland
Council of National Defense kindly placed at the
disposal of the Public Health Service a fully
equipped hospital train for use in its influenza
work.
The problem of supplymg nurses was much
Fig. 3. Graduate dietiti:
the influenza hospital.
more difficult, for it was found almost impossible
to discover nurses or trained attendants who were
not already extremely busy on urgent medical
work, mainly in training camps. A limited num-
ber of nurses and trained attendants were secured
by the American Red Cross and mobilized for
emergency service in the communities most se-
verely affected. It was made clear from the out-
THE MODERN HOSPITAL
427
ganization of relief kitchens. In Washington a
relief kitchen, under the supervision of Mrs. W. G.
McAdoo, was opened at the old Emergency Hos-
pital. Upon application, hot broth and gruel was
delivered free of charge by automobile to any
address in the city. This undoubtedly has re-
lieved a great deal of the trouble.
A RESERVE CORPS TO DEAL WITH FUTURE EPIDEMICS
This epidemic has demonstrated, as never be-
fore, the imperative need of a permanent organi-
zation within the Public Health Service available
for emergency work. To a large extent, such an
organization can exist in skeleton form, but if
widespread epidemic outbreaks of disease or other
great public health emergencies are to be dealt
with successfully, steps must be taken to avoid
having to create a new organization with each
emergency. This difficulty has been met by the
passage of a joint resolution, pending in Congress
since June, 1917, which provides for the estab-
lishment of a reserve in the Public Health Service.
The resolution became a law with the President's
approval on October 27, and the organization of
the reserve, which is now under way, will un-
doubtedly have a profound influence in safeguard-
ing the health of the nation.
OUT-DOOR TREATMENT OF SPANISH INFLUENZA
Loss of Life During Recent Epidemic Greater Than That Caused by War — Open-Air
Treatment Tried with Excellent Resuhs— Statistics Prove Superiority
of Open-Air Cure— Suggestions for Cubicle Construction
to Handle Future Epidemics
By W. a. brooks, A.M., M.D., Acting Chief Surgeon, State of Massachusetts
PROBABLY the real history of the epidemic of
the so-called "Spanish influenza" will never
be known. Perhaps it is just as well that all of its
horrors should not appear in print. It is neces-
sary, however, that some of them should be
known in order that proper precautions may be
taken to guard against its probable recurrence
next fall. When it is considered that this epi-
demic has already cost in the neighborhood of
FIk'. 1. Street at Camp Win. Brooks, Corey Hill, Mass.
one hundred thousand lives — more lives than we
have lost in the war with Germany — the magni-
tude of the catastrophe is perfectly apparent.
Open-air treatment for diseases of the respira-
tory tract has been known and practiced for many
years. It really is nothing new; yet its applica-
tion to cases of influenza was, in the beginning,
largely the result of experience. It was inter-
esting to see how the problem worked out. The
Fig. 2. Hospital at Gloucester, Mass.
first tent hospital for the treatment of influenza
cases was established by the recruiting service
of the United States Shipping Board, with the
aid of the authorities of the state of Massa-
chusetts.
Between 5,000 and 6,000 men in training were
crowded together in four or five ships stationed
at East Boston. Out of this number about 1,200
cases of influenza and pneumonia developed.
Three hundred and fifty-one of the worst cases
428
THE MODERN HOSPITAL
out of the 1,200 were treated at the tent hospital,
and of this number thirty-six patients died. Early
in the history of the camp it was learned that the
worst cases of pneumonia came from quarters on
the ships whei-e the circulation of air was the
poorest.
This was the first hint towards the proper
treatment. Later on, it became known, through
the cultures from the throat and nose, that the
epidemic was due, not to the influenza bacillus
alone, but also to at least two, possibly three, types
of the pneumococcus. Type three of the pneu-
mococcus was apparently the most dangerous, and
one for which there is as yet no known serum.
The reports from the autopsies at the naval
hospital showed the presence of abscesses in the
lungs, and, together with these abscesses, were
areas of gray and red hepatization. The hearts
in many cases wei-e absolutely normal. Clinically,
it had been noticed at the camp hospital that, as
cases became cyanotic, the use of ordinary heart
stimulants, such as digitalis and strychnine, had
absolutely no effect; and, when it became known
that the deaths were due, not so much to heart
failure as to the fact that the lung area was
markedly dimini-shed, it became apparent why the
heart stimulants had no effect. The patients
were simply drowned.
These facts being known, the treatment de-
manded was that the patient should be given as
much air as possible. Consequently, on pleasant
days the patients were moved out into the air
and sun. The resultant improvement was most
marked and startling. Practically without excep-
tion, after a day in the sunlight, temperatures
were lower at night than they had been in the
morning. The attending physicians at the camp
took courage, and, when cases were brought in
early enough in the disease, recoveries became
more and more frequent. A great number of
patients with single and double pneumonia got
well, and it was interesting to see them return-
ing to the ships sunburnt after such a serious
illness.
An interesting comparison of some of the tent
camps with indoor hospitals can be made. For
example, in a small hospital near Boston, the
number of patients treated during the epidemic
was 87. Of this number, 29 died. At an out-door
hospital at Barre, Mass., 114 patients were treated
and only four of them died. A general hospital
in one of the neighboring cities to Boston had
about 76 patients. Out of this number, 20 died
within three days, and 17 nurses came down with
the disease. As I have stated above, out of 351
patients at the first tent hospital, only 36 died.
These facts speak for themselves.
Without the figures being complete, it is safe
to assume that, where cases of influenza and pneu-
monia have been treated in wards of general hos-
pitals, the rate of mortality has run from 30 per
First floor plan and elevation of cubicle construction sug-
gested for out-door treatment of respiratory dis
cent to 50 per cent. In the out-of-door camps the
rate of mortality has run from 5 per cent to 18 per
cent. This in itself should be a convincing argu-
ment in favor of out-of-door treatment of this
disease.
As an interesting contribution it can be stated
that 8,000 boys training for the navy were put in
the tents at Framingham, Mass., and at the end
of two weeks, as far as I have been able to learn,
in only 2 per cent did influenza develop.
It has been extremely difficult, however, to
drive these facts home and to convince the medi-
cal profession that a patient is much better off
out of doo)'s than in any room with all the vv^in-
dows open. In such an epidemic as has recently
swept this country it has been proven without
THE MODERN HOSPITAL
429
doubt that it is absolutely dangerous to treat ten
or twenty cases in one room. The drop-sheet be-
tween the beds unquestionably make it less dan-
gerous, but so many of the nurses in attendance
are stricken with the disease that the efficiency
of the hospital staff is greatly diminished.
Experience with this epidemic should revolu-
tionize the construction of hospitals, and it is yet
to be proved whether it is not inadvisable to treat
twenty or more cases of any disease in a single
room.
The great disadvantage of a tent hospital is
that the nurses in attendance are very much ex-
posed in bad weather. The patients in the tents
can get along very well, but the nurses in attend-
ance have no protection. Consequently, looking
to the protection of the nurses as well as the
benefit of the patient, the idea suggests itself of
the building of cubicles facing the south, with
room enough for two beds, and all of the cubicles
connected on the north side with a passageway
which might be heated in cold weather. On the
north side of the passageway can be located the
diet kitchen, hopper-room, and toilets. The space
between the cubicles should be at least 9 feet.
The shutters of the cubicles should all open in-
ward, and the walls should not extend clear to
the roof.
A second criticism of the tent hospital is that
there is always a dead-air space at the top of the
tent. Hence, it would seem almost advisable to
have the roof of the cubicle arranged in such a
manner that it could be lifted.
The construction of these cubicles is much less
expensive than the ordinary hospital construc-
tion, and it affords an opportunity of getting all
the air and sunshine available. In addition, the
front of each cubicle should be constructed in
such a way that it could be opened out and in
sunny weather the patient could be rolled out
into the open so as to get the sun all day long.
Every town of any size should have one of these
cheaply constructed cubicle hospitals in order that
on the outbreak of any epidemic the first few
patients could be immediately taken care of. If
many cases develop, the original units could be
supplanted by others or by tents.
Personally, I am absolutely convinced that this
would not only be a wise procedure, but an abso-
lutely essential one if we are to be prepared for
what is practically sure to happen. If it is not
an epidemic of influenza, it will be an epidemic of
some other contagious disease, and certainly this
country has paid the price for its experience with
this epidemic.
It has been roughly estimated that, in most
communities, the value of a human life is about
$5,000. On this basis, there has been a loss to
this country of practically $500,000,000 during
this epidemic, an estimate which should bring
home to us the tremendous economic loss in an
epidemic such as the one just experienced.
A HOSPITAL IN A FRENCH CHATEAU
AN ENGLISH HOSPITAL FOR AMERICANS
the Hospitals on the Other Side Where Gas Cases
Are Studied and Cared For
This beautiful chateau in Bellevue, Prance, was formerly
the home of Isadora Duncan, the dancer. It is now (or
perhaps we may write "was") the American Hospital for
the Study and Cure of Gas Cases. If the need for its use
for this purpose has not yet passed, it will, of course, soon
be at an end with the cure of the cases now cared for,
when "gas cases" will become the subject of a chapter on
the gruesome curiosities of medical history.
Good Results in the Care of Pneumonia Achieved in L'n-
pretentious Architectural Surroundings
It would be hard to imagine a more complete contrast
to the chateau pictured in the opposite column than this
pneumonia ward of the American Red Cross Hospital at
Mossley Hill, Liverpool, England, which looks more like
a big drill hall than a hospital building. Nevertheless, the
London department of information of the American Red
Cross from which this picture comes, reports that the
army doctors are enthusiastic about it, and call it the
best thing of its kind in England.
430 THE MODERN HOSPITAL
A COOPERATIVE ECONOMY CAMPAIGN IN ALL DEPARTMENTS OF THE HOSPITAL
Savings in Chemicals and Druds, Nursing and Housekeeping Supplies, Labor and Fuel—
The Human Element the Greatest Factor in the Economy of an Institution
By ASA S. BACON, Superintendent, Presbyterian Hospital, Chicago
THE Presbyterian Hospital has been fortunate
in securing splendid cooperation throughout
all departments in the conservation program on
which our government has asked us to act. We
have always believed in avoiding unnecessary
extravagance, but the war, by placing economy
on the high plane of patriotic duty, has taught us
manv new wavs to save and has intensified the
interest felt in thrift. Eveiyone feels pride in
having helped to eliminate waste without lower-
ing the standard of service given, and this ap-
plies even to departments which in most cases
feel no concern for expense and ordinarily resent
being asked to consider this subject.
THE LABORATORY
It has been found possible to institute some
verj' important economies without in the least
hampering the work or injuring its quality. The
extent of this saving may be indicated by the
statement that in December, 1917, the cost of
drugs used in one service alone was $63, whereas
in September, 1918, the cost of drugs for all serv-
ices together was $25.
This has been accomplished in part by a sys-
tem of careful checking. The drug room checks
the supplies requisitioned by the laboratory, and
the latter checks the chemicals given out to the
interns.
It has been found that to give out chemicals
in dry form encourages waste. By giving out
glacial acetic acid in solution, for instance, our
laboratoiy has cut down the expenditure of one
service for this chemical by three-fourths.
Another saving is effected by care in making
tests. For instance, the gold chloride test is suc-
cessful only if the utensils and material are clean
and sterile; also, it should be made up with triple
distilled water to get best results.
The polariscope test for sugar in the urine is
much less expensive than chemical tests and is
sufficiently accurate for clinical purposes. The
initial cost of the polariscope is only about $55,
and its use has been a decided economy.
THE PHARMACY
A great many of the economies practiced in
our pharmacy were explained in a former paper.^
One of the advantages which the Presbyterian
Hospital has always possessed from the point of
view of economy in the pharmacy is the fact that
the members of the medical staff prefer to con-
fine their prescriptions, as far as possible, to offi-
cial substances. There are great advantages in
the use of pharmacopeial drugs. Not only are
they required by law to meet a fixed standard, be-
ing staple substances, but they are also more eco-
nomical to use than the non-pharmacopeial drugs.
We find it a saving to manufacture more of our
Fig. 2. Sorting
om in the laundry. Damaged (
returned to the sewing room.
drug supplies than we might if our pupil nurses
did not spend a month in the pharmacy. There
is an immense saving in making syrups, essences,
tinctures and elixirs. In the matter of manufac-
turing, no rule of economy can be laid down that
will apply to all hospitals.
NURSING DEPARTMENT
In the nursing department our main economies
are naturally in the use of gauze and cotton.
•Bacon, Asa S., and Gray, WiUii
macy, April, 1918, X. 291.
Economy in the Hospital Phar-
THE MODERN HOSPITAL
431
We have replaced absorbent cotton to a large
extent with non-absorbent; in fact, we use ab-
sorbent cotton only for eye dressings. We make
applicators out of scrap cotton, and the plugs for
specimen tubes out of waste cotton. Washed and
resterilized gauze is, of course, used for dressings.
In many respects we have found economy no
hardship. For instance, we find the bed-pads
made out of old linen and padded with waste
gauze preferable to those made of absorbent
cotton. Perineal pads are made entirely out of
small scraps of washed gauze.
HOUSEKEEPING DEPARTMENT
I have already told how we conserve food by
the cooperation of patients in ordering from
menus. -
Servings are, of course, watched to see that
amounts of food in excess of what will be eaten
are not given out.
The war, moreover, has given us a background
from which to appeal to our domestic help for
cooperation in economy, and they have responded
as they would not otherwise. Before the war
they would have felt injured, for instance, if they
were not allowed to drink milk freely. Now it
is possible to make them understand that milk
is too much needed as a food to be used for allay-
ing thirst by people who do not need it. Ac-
cordingly, we have discontinued the serving of
milk at the noon-day meal and do not permit it
to be poured at breakfast and supper until the
meal has begun and there has been a chance to
satisfy thirst with water.
In the sewing room the opportunities for sav-
ing are endless. We cut down full-sized sheets,
spreads and blankets, when worn at the ends, for
=Bacon. Asa S. : Cooperation of Physicians. Nurses, and Patients
Enlisted Successfully in the Presbyterian Hospital, Chicago, July. 1917,
use in the children's wards. The bath towels used
in the private pavilion are cut off and hemmed
for use in the wards, later transferred to the
help's quarters, and finally cut up into wash-
cloths.
We have eliminated skirt gores in gowns for
the sake of economizing material. The gores
from the sleeves and back are used to make belts
for nurses' gowns. Other scraps of new material
are used for neckbands and drawstrings. We
now use very little tape.
We used to employ sixty-inch rubber sheeting.
Since the price of rubber has gone up we have
made a considerable saving by using forty-inch
■^^HV ^illl
pipy ,, ' ".™i*!
■■H
^Wi
11
^^^Hl
Fig. 4. A corner of the sewine: room, where all waste material is
reclaimed.
sheeting, piecing on old rubber at the sides to
turn under the mattress. The old scraps are used
for the scrub-maids' knee pillows.
A sudden demand for operating room masks
was the occasion for the utilization of strips of
new scrim left over from window curtains.
Masks of this scrim proved cool and comfortable
and made a "hit" with the surgeons and nurses.
A very simple record is kept of the cost of
each article made in the sewing room, so that
we know just what the saving is on each.
THE LAUNDRY
In the laundry the chief economy effected has
been in the reduction of help through the use of
faster machinery. We have put in a fast mangle,
capable of turning out seventy feet of laundry,
against thirty-five or forty-five formerly. We
get as much work from one girl tending two fast
presses tandem as used to be turned out by three
body ironers. The use of pins has been discon-
tinued, and paper bands are used instead.
THE POWER PLANT
We save in electric current and wear and tear
of machinery by charging our signal system dur-
ing the twelve night hours. We economize fuel
by heating water with exhaust steam. Labor is
saved by the use of the automatic stoker. Among
432
THE MODERN HOSPITAL
the materials saved in this department are oil
and cotton. We collect the oil which drips on
the floor around the machinery, filter it and use it
again. We use scraps of washed gauze instead of
waste in the engine room.
MISCELLANEOUS ECONOMIES
One of the most important miscellaneous econ-
omies is in the use of soap. When thoroughly
seasoned, soap will not waste as it does when
fresh. By cutting one pound bars in halves and
thoroughly drying them on racks in the store-
room for a year before use, the Presbyterian
Hospital has been able to cut down its consump-
tion of soap to a third of that of another institu-
tion which handles no more people.
We save in rubber gloves, in the first place, by
buying a good quality, medium or heavy weight,
standard sizes. Their life is prolonged as far
as possible by patching. When no longer useful
as gloves they are cut up, the wrists making rub-
ber bands and the fingers being used as finger
cots. The fragments that are past use are sold
as old rubber. It is worth while, we find, to re-
pair our own rubber goods, such as gloves and
hot water bottles, etc.
The life of metal pails has been trebled by
screwing to the bottom of each a wooden plug,
which touches the floor and does not permit the
metal bottom to sag. The top of the screw is
soldered over to prevent leakage. It also makes
the pail less noisy.
I had a special forceps made with a wide lip
to squeeze the alcohol out of sponges. This
forceps has entirely eliminated the waste of alco-
hol from squeezing the sponges with the fingers or
with the ordinary forceps.
Cuttings from the folders in which histories
are kept are cut up into cards, which are used for
visiting passes, etc. Scraps of tissue paper, such
as come around oranges and lemons, are saved
and used for toilet paper for the help.
In fact, our aim is not to destroy, but to save
and use every bit of potentially useful material.
THE HUMAN ELEMENT
After all, the largest factor in institutional
economy is the human element. It is impossible
to practice economy successfully with a discon-
tented, disloyal force, or with a constantly chang-
ing force. For many reasons, an old employee
who gives satisfaction is worth much more than
an equally competent outsider.
The Presbyterian Hospital follows a policy
which insures a contented, loyal body of perma-
nent employees, who know our work and our
ways. We pay what the employee is worth, and,
if an individual has the capacity and ambition
to advance, we give him or her the opportunity.
The result is, our employees understand that the
welfare of the Presbyterian Hospital is their own
welfare, and they work for us not only with their
hands, but with their heads and their hearts.
RESULTS
Ninety-six percent of our employees have stood
by the hospital during the war and are still with
us. They are all in fine physical condition and
reasonably satisfied.
The amount of alcohol used has been reduced
50 percent. Chemicals used in the laboratory
have been reduced 75 percent.
Shelf paper and paper used in dresser and linen
drawers have been entirely eliminated.
Butterine is used throughout the house except
for private room and special feeding patients.
Flannel bandages have been discarded entirely.
Gauze bandage rolls have been reduced 75
percent.
The amount of gauze has been reduced
25 percent.
Lemons and oranges have been reduced 80
percent.
Sugar has been reduced 50 percent.
All meats and fats have been reduced 25
percent.
Similar reductions have been made in all de-
partments where economy does not interfere with
the service.
Fig. 5. This Rroup of floor maids shows a part of the two hiindrorl s,nA fiff,. «.^.>i-,. i. i. <•-......
during the war. Miss Lucy J. Clark, matron^s stSme at the left 'krVm^^^^^ ^V^}^^''^r .<^«^P«^^t^d
twenty-three years of faithful service to the hospital ^'^^^ standing on the left is Miss Am
linistration
has given
THE MODERN HOSPITAL
A LAUNDRY SYSTEM WHICH HAS PROVED SUCCESSFUL
433
Clean and Soiled Clothes Separated Through Entire Laundry Process— Triplicate Forms
and Careful Checking Prevent Loss of Articles— Strict Economy Permits
Use of Best Quality Supplies— Weekly Schedule of Patients' and
Employees' Work
By MRS. LINA STRYKER FISH, General Housekeeper,
IT is rather the exception to the rule that the
utilities of the hospitals or institutions are ade-
quate for the census. In the case of this sani-
tarium, the exception is the rule as far as the
laundry is concerned. The board and superin-
tendent, with great forethought, have enlarged
the laundry with the growth of the sanitarium,
and the result is that we have a laundry fully
equipped for our needs.
I thought it might be of interest to the readers
of The Modern Hospital to know something of
the routine work here.
As in all well-organized places of this kind, it
is an invariable practice here not to have soiled
clothes cross the clean. One entrance is used en-
tirely for soiled clothing, and the succeeding
steps of the process take the clothes through
the different stages until they are ready for de-
livery from the exit of the clean-bundle sorting
room.
I will first tell of the collection of soiled
clothing. Here, as in commercial laundries, the
making out of the printed list is very important.
My experience has been like that of everyone else
in this line, that there are few persons who can
make out a list properly. Our system, while it
may seem complicated at first, proves after a little
practice very efficient and easy. The persons
using it grow to have such confidence in it that
they adhere very closely to the forms.
The forms are printed on sheets of three colors,
yellow, pink and blue, and are put up in blocks.
They are used, of course, with carbons. The date
and unit are designated at the top. Then comes
the list of articles, alphabetically arranged and
including every possible article, even to dust
cloths. After the articles have been properly
listed, the name and position of the sender are
signed at the bottom. This assists in locating any
articles lost. The yellow slip is retained by the
sender, and the blue and pink slips are sent with
bundle. The bundle system is used exclusively,
the same as in commercial laundries, and it makes
no difference whether the night gown and under-
wear of a bed patient or the flat work for a ward
or cottage is being sent, the same system prevails.
When this soiled linen is received in the soiled-
linen receiving room, if it is personal clothes, it
is sent to the marking machine room. The flat
Municipal Tuberculosis Sanitarium, Chicago
work, including bedding, linen, blankets, etc., is
sent to the sorting room, for these articles have
been marked before putting them into circulation.
The clothes are opened, each bundle separately,
and checked with the pink and blue slips. If
there are any discrepancies between the bundle
and the lists, the checker makes a notation be-
side the number marked by the sender; thus, if
only three shirt waists are received and the blue
slip says four, the checker marks both slips "3."
After the bundles are checked, each article is
looked over to see if it is properly marked, and, if
not, the marking is done. As there is a special
place on each garment for marking, this part of
the work is comparatively easy. When this is
done, the pink slip is sent to the clean-clothes sort-
ing room, and the blue to the housekeeper's office.
The pink slip is fastened on the box with a clip.
An adequate number of boxes is supplied, which
insures sorting for the clothing of each individual.
The pink slip goes with the clothes until they are
finished and made into clean bundles for distribu-
tion and is then returned with the bundle to the
original sender.
The yellow slip retained by the sender must
check with the pink and also with the blue
retained in the office. In case of loss of articles,
the complainant must go to the office with the yel-
low and the pink slips, and, as the office has the
blue slip, it is very easy to give the final checking
and place the blame where it belongs. The blue
slip sent to the office also assists in the scheme for
correctly crediting the laundry with the value of
work done by it. Every article with its commer-
cial estimate is entered on a ledger, so that we
are able to say exactly what is its real value in
dollars and cents. Thus you see the usefulness
of making out laundry lists correctly and check-
ing up with them as an aid in obtaining a grand
total.
We also keep an accurate accounting of all our
supplies, such as soap chips, Wyandotte soda,
starch, and, in fact, to the ounce of bluing, so that
at the end of the month we can tell exactly what
it costs to accomplish the work as far as supplies
are concerned, as well as the value of the work
and supplies.
Another thing that is well to consider is the
fact that, as far as is possible, unless they are
434
THE MODERN HOSPITAL
prohibitive in price and impossible to obtain, it is
best to adhere to well-tried supplies. If substi-
tutes are used, they should be worked out well be-
fore they are tried with the regular work. Of
course, it is everyone's duty to obtain the simplest
a T
CITY OF CHICAGO
Municipal Tuberculosis Sanitarium
n„. 101
LAUNDRY:
The following goods are herewith enclosed b>
gnatic
No.
V
ARTICLE
No.
V
ARTICLE
No.
V
ARTICLE
AproM-CoIored....
Skim— Dresf. -,
Sleepers....
Socki
Spreadi
Giiimpe.
Boy»' Jicketi
Table-Clolbi ... -
'• — Coveti . , .
•• -Top.,,
Tiei
Towelt— Bath
■' -Diih
■■ -Gl.......
■' -H.nd-.
•■ — laJiiid«»l..
■• -Roller..
Under»hirli
Undervciti .... .
Union Suit!
Vciu
Waiil Bands
WaiiU..
" W«i«ti-
Kimonoi
Bur«u Corer.
ChifdT«n-| DreM«...
Nipkifii
PmI
Curtaini— Long
Dale Sif>
n«-H
Tuberculosis Sani-
and the most inexpensive things that will accom-
plish the purpose.
So far, by the strictest economy in their use,
we have been able to continue with many articles
we had used before the changes in price brought
on by the war. To show that our arguments
are sound and can be substantiated, I will say
that the biggest part of our flat work for beds,
etc., has been in use for nearly four years. Re-
sults such as this can be obtained only by properly
listed work and care in ordering supplies. It is
but practical economy to keep the laundry to its
highest grade, from the standpoint of regular
service for everything going through it, and also
for personal and bodily comfort, to say nothing
of the appearance given in the working and using
of articles laundered. Everyone wants to coop-
erate with the system, because everyone feels its
value personally.
We have a very comprehensive method of col-
lecting and delivering soiled and clean laundry.
The lists for collection and delivery are made out
in schedule form and placed in every unit of the
sanitarium. Collections and deliveries are made
by a truck, with a trained person to do the work.
Each day's work is done at the regulation time on
the schedule, and all clothing must be ready at
this time to be picked up. One of our units is
one-fifth of a mile from the other, with all the
outlying cottages and buildings, so it is evident
that a time schedule must be adhered to.
Monday at 8 a. m. all the wearing apparel of
each employee is gathered, and this, with the flat
work for every employee, is cleared up with the
washing, while the patients' ironing, which was
collected on Saturday's pick-up is finished up.
On Tuesday the flat work is mangled and the
ironing for the employees starts, so that work
for employees and patients never goes through
at the same time, either in the wash, or in the
ironing. Wednesday is shirt and collar day, with
the finishing of the employees' clothing, which
is delivered the same day, leaving the last of the
week, Friday and Saturday, for finishing up the
work of the patients. Table linen, which we have
for employees only, is sent every other day, and
towels and kitchen articles, as well as specials for
Fig. 2. Monthly summary of work done by laundry of Chicago Municipal Tuberculo
litarium. Actual
THE MODERN HOSPITAL
435
the infirmary and the babies, are sent every day.
We are doing work for between eleven and
twelve hundred people with a roster of five men
and nineteen women, including the man on the
truck who collects and distributes. They are di-
vided into classified groups or crews for each par-
ticular kind of work, hand-ironing ironers, body
ironers, shirt and collar workers, manglers, etc.
Employees capable of being taught the work on
the different machines are given this training, so
that we always have an understudy. Great care
should be used in the organization of the work
and in the selection of persons checking in, to
see that they thoroughly understand the impor-
tance of that particular line. In no department
of the hospital or institution is there more need
for organization than right here. It is very es-
sential to look after practically small matters, for
they make the final success. The placing of the
right people for doing special lines of work, the
a a
B
A
X^
C
D
HO©®
c©
7^
F
1 I I I IjI
M ,-
G
JMI'I'hl
a
J
K T L
j| I I rrr
I bi I i.^^nrr
0
I®1
M
00^ r:
-^V
SCALE
m.
5' 10' 15 10'
P
flflflflflflfl
[1=03] [I=[Tp ©D ®D
H
Fig. 3. Plan of the laundry of the Chicago Municipal Tuberculosis Sanitar
Platform
Soap room
Supply room
HaU
Wash room
Receiving room
Sorting room
Office
I. Locker room
J. Dry conveyor
K. Clean sorting and delivery
L. Ironing room
M. Drj- room
a. Soap tanks
b. Washers
c. Tubs
d. Tanks
e. Extractors
f. Slirt starchers
g. Starch boiler
h. Sprinkler
i. Men's lockers
j. Sorting boxes
k. Sorting table
1. Ironing tables
m. Tables
n. Mangles
o. Tumbler
p. Presses
q. Shirt ironers
r. Collar ironers
s. Body ironers
436
THE MODERN HOSPITAL
making of the bluing, the careful weighing out of
the soap chips and the Wyandotte soda for soap,
and the boiling of the starch all make a successful
week's work.
If the foundation is well laid, you have results
of which you can be proud. What gives greater
comfort than clean, sweet-smelling clothes? Good
laundering is a service that is fully appreciated
perhaps only when something calls attention to
the want of it, and it is but practical economy
to keep this service up to the highest standard
of efficiency.
VENEREAL DISEASE CLINICS
The War Department Calls on the Hospitals of the Country to Establish and Maintain
Venereal Clinics as a Necessary War Measure — Essential Require-
ments for Maintenance of Efficient Clinics
By MICHAEL M. DAVIS, JR., Director of the Boston Dispensary
1. Why combat venereal diseases? — Because
they are prevalent, contagious and dangerous.
Three million active cases of syphilis and gon-
orrhea in the United States today is a low esti-
mate. Among some groups of the population the
proportion is very much higher. Tests made of
the adult admissions to a number of general hos-
pitals in different parts of the country have usu-
ally shown 20 percent or more of cases of syphilis
(not admitted as such).
Both syphilis and gonorrhea are contagious.
They affect the present, and also the next genera-
tion. Their prevalence saps national stamina.
2. WJiTj combat these diseases now? — Official-
ly we are still at war, and the conclusion of peace
will not mean immediate demobilization. Syph-
ilis and gonorrhea are the most serious single
causes of illness and inefficiency in the army. It
has been demonstrated that the sources of these
infections lie not within the army itself, but in
civilian life. The War Department, the United
States Public Health Service, the Council of Na-
tional Defense, and the War Camp Community
Service have therefore joined in a national cam-
paign to bring every civilian community to take
aggressive steps to control, treat and prevent
venereal disease.
3. Where do the hospitals come into this pro-
gram?— Adequate facilities for the diagnosis and
treatment of syphilis and gonorrhea are one of
the outstanding necessities. The treatment of
these diseases requires special skill and equip-
ment, and must be long-continued to be effective.
For these reasons, the resources of private med-
ical practice are recognized everywhere by health
authorities as inadequate to provide for more
than a small fraction of the cases of venereal dis-
ease.
The hospitals of the country are the chief insti-
tutions which have the equipment and the neces-
sary medical organization out of which the needed
organized clinical facilities can be built.
Jf. Why have venereal clinics? — Because the
bulk of cases of syphilis and gonorrhea can and
should be treated as ambulatory cases. Out-
patient clinics are the chief means through which
treatment facilities can be provided for them.
5. Are hospital beds necessary? — Yes. Not for
the average case, but for a certain proportion of
cases, the use of beds is highly important. Some
patients are ill enough to require bed care for a
period, and others can be kept under control only
by being in an institution until the period of great
infectiousness has passed.
6. Have many hospitals successfully main-
tained such clinics? — Previous to the war, a cer-
tain number of representative general hospitals
had done so. During the present year, as a result
of the war program, about a hundred additional
hospitals have established such clinics, but it is
still true that, out of over two thousand hospitals
in the countiy doing public work, nearly 85 per-
cent have as yet no clinics for venereal diseases.
7. How are such clinics best maintained? — It
is best, when possible, to have clinics for the
treatment of syphilis and gonorrhea carried on as
part of a general out-patient department which
has clinics for other diseases also.
Nearly half of the two thousand hospitals
just referred to have some out-patient depart-
ment already, of which venereal clinics could be
made a part.
S. What are the six essential requirements of
efficient clinics? — (1) Staff; (2) equipment; (3)
laboratory facilities ; (4) follow-up system ; (5)
social service; and (6) coordination with the lo-
cal public health authorities.
Details of equipment and management will be
outlined in a series of articles in The Modern
Hospital, beginning in this number, page 481.
9. Need expense be an obstacle? — No. In the
first place, a number of representative hospitals
have maintained such clinics without any net ex-
pense, by charging patients fees sufficient to cover
THE MODERN HOSPITAL
437
the cost. A large proportion can and will pay.
Such pay clinics are not at all incompatible with
maintaining a large amount of charitable or fi-ee
work for patients who can pay little or nothing,
any more than the maintenance of paying or part-
paying hospital beds is incompatible with the
charitable and free work of the same hospital.
As a further aid, a number of states have ap-
propriated money to assist venereal clinics when
they come up to officially recognized standards of
efficiency.
The United States Government has appropri-
ated a large sum of money to fight venereal dis-
ease throughout the country. This money will
shortly be available to the several states in pro-
portion to population, and may be distributed by
state authorities to assist local treatment facili-
ties such as clinics.
10. What should hospitals do noiv? — If they
have clinics treating syphilis and gonorrhea, make
sure they are up to standard of efficiency as to all
six requirements.
If they have not such clinics, do their part in
a great national program by establishing them.
HEATING AND POWER PLANT ECONOMIES FOR HOSPITALS*
Coal Economy a Matter of Patriotic Duty and Personal Benefit— Hu^e Waste in Average
Boiler Plant Preventable— Careful Survey of All Steam Plants Proposed— Funda-
mentals and Recommendations of National Economy Program
By D. D. KIMBALL, Member New York State Commission on Ventilation, Past-President American Society of
Heating and Ventilating Engineesis
Never before have power plant economies as-
sumed such importance as at this time. Last
year's fuel scarcity is still fresh in the minds of
all, and similar conditions are to be feared during
the coming winter. Every fuel-user faces a pa-
triotic duty which is, at the same time, a matter
of personal benefit. Every ton of coal saved is
so much energy released for the promotion of
essential war industries and a bit of relief in
freight congestion.
Dr. Howell has stated before this society in an
admirable paper' that "about 10 percent of the
expenditures of the average hospital are for the
engineering department." Doubtless, owing to
the present high costs of fuel and labor, this
proportion of cost is now increased. No depart-
ment of hospital maintenance will be found a
more fruitful field of study to promote economies
^not that hospital plants are more inefficient
than others, but because the vast majority of
heating and power plants are notoriously waste-
ful.
For years mechanical engineers have empha-
sized the possibilities of improvements to be made
in the operation of heating and power plants, but
little heed has been given to their statements. It
has recently been stated that "it has been deter-
mined that the waste in the average boiler plant
alone is 42 percent, the most of it preventable."
It is certain that few plants are so equipped and
operated that a 10 percent, or even 20 percent,
saving may not easily be made in operating costs.
•This paper was prepared for presentation at the Twentieth Annual
Convention of the American Hospital Association, but it was reaa oy
title only.
1 Boiler Room Economics, 1915.
And a saving of 10 percent of the fuel used means
much more in dollars than was the case two years
or more ago. Millions of tons of coal must be
saved to meet the excess of demand over supply,
and this total saving must be accomplished by
making some saving in every plant.
So important is this matter now considered by
our government that a special bureau of conserva-
tion of the United States Fuel Administration has
been formed and a careful survey of all steam
plants is proposed. A form of "Standard Ques-
tionnaire Covering the Operation of Steam Power
Plants" is to be sent to all steam-power plant own-
ers, with a view, first, to securing more efficient
operation of all plants to reduce fuel consumption,
and second, of curtailing the allotment of coal to
those plants which fail to comply with the recom-
mendations of the fuel administration in regard
to economical methods of operation.
The fundamentals of the national program are
as follows:
1. Personal inspection of every power plant;
2. Rating and classification of every power plant in
the country into five classes, depending upon the thorough-
ness with which the owner conforms to the recommenda-
tions of the U. S. Fuel Administration.
3. At the discretion of the Federal Fuel Administra-
tion, curtailment or complete stoppage of supply of coaL
The standard recommendations of the United
States Fuel Administration are substantially as
follows :
1. Puel — That means be provided for measuring and
recording fuel used each shift or day;
2. Water — That boiler feedwater be heated by exhaust
steam or waste heat, and measured;
3. Air Supply — That a correct amount of air be sup-
438
THE MODERN HOSPITAL
plied to the fuel, and that proper means be provided for
measuring and regulating the draft.
4. Clean Heating Surfaces— That boiler heating sur-
faces be kept clean inside and out.
5. Boiler and Furnace Settings— That the furnace
and setting be kept in good repair and free from air leak-
6. Insulation— That exposed steam surfaces wasting
heat by radiation be covered with suitable insulating ma-
terial.
7. Engine-Room and Heating System— That, wherever
possible, exhaust steam be utilized to the exclusion of
direct steam from the boilers. (The plant should be de-
signed and operated to produce no more exhaust than can
be efficiently utilized in heating and process work).
8. Supervision— {!) That a competent employee or
committee be detailed to supervise the work of fuel con-
servation in the boiler and engine plants; and (II) that
a competent committee be appointed in charge of the work
of fuel conservation in the buildings and shops outside of
the power plants.
As long as the war lasts, no plant using coal
for generating steam or for heating purposes can
be considered too small to require the careful at-
tention of some one within the organization. Fuel
must be saved, no matter how small the quantity,
and this is just the point which must be empha-
sized. Necessity has brought recognition of facts
of which the interests of the fuel user himself
should have long ago caused him to take heed.
As serious, however, as this condition now ap-
pears, a more enduring fact faces us. As high
as is the present cost of fuel and engineering
labor, the future cost thereof will not be materi-
ally less. For the future, therefore, as well as for
the present, the promotion of heating and power
plant economies is most essential.
The attention of those interested in this sub-
ject is recommended to the Journal of the Ameri-
can Society of Mechanical Engineers, July, 1918,
"The Economical Use of Fuel."
Existing conditions warrant a careful consider-
ation of those phases of the fuel consuming plant
in which occur the greatest wastes, and means by
which economies may be secured. In this connec-
tion, special emphasis will be laid upon those fea-
tures which are most emphasized in the question-
naire of the Fuel Administration.
BOILER AND FURNACE SETTING
Although this is the fifth subject in this ques-
tionnaire, together with the matter of clean heat-
ing systems, it is credited with thirty-two points
out of one hundred, so that it becomes exceedingly
important that the best conditions should exist in
the boiler installation and its operation. Special
care should be exercised to keep the boiler clean
inside, eliminating all scale and sediment. Simi-
larly, the boiler must be kept cleaned on the out-
side. The tubes should be cleaned at least every
day, and preferably on every shift. The collec-
tion of soot should not be permitted at any point.
The masonry work should be kept in good con-
dition. It is often said that more fuel is wasted
through leaky settings than in any other way.
All cracks should be stopped up with some good
filler and a coat of first-class plastic cement
should be applied to seal all small cracks and
pores in the brick. The settings should be gone
over at regular intervals by a competent man.
Good results are also obtained by applying elastic
coatings which are available for this purpose.
Access and clean-out doors should be made thor-
oughly tight. Leaks about the blow-off and other
pipes connected to the boiler should be eliminated.
The grates should be of the best design and in
good condition. Warped, broken, or otherwise de-
fective grates should be replaced.
Twelve points out of one hundred in the ques-
tionnaire are allotted to the matter of air supply.
Insufiicient draft or an excess of draft seriously
affects boiler efficiency. The smoke connections
from the boiler to the chimney should be well and
tightly constructed. An adjustable damper in the
throat of the smoke connection of each boiler
should be provided and another damper in the
main smoke connection. The latter should be
automatically controlled by an approved damper
regulator. Every boiler should be equipped with
a reliable draft gauge, so that the engineer may
determine whether his draft is at all times suf-
ficient. A proper draft gauge would also tell
whether the fire is too thick or too thin, whether
it is evenly spread, or whether holes in the fire
bed exist, and whether, in the case of battery
boilers, some boilers are overloaded, while others
are lagging.
It is often found in large plants that more boil-
ers are operated than are necessary, with a les-
sened efficiency. In some cases boilers are un-
necessarily and undesirably overloaded.
AUXILIARY EQUIPMENT
All boiler trimmings should be kept in good con-
dition. Pumps should be of an efficient type and
free from leakage. Feed water heaters are most
essential. It is generally allowed that for each
ten degrees increase in temperature at which the
feed water is supplied to the boilers a 1 percent
saving is made in the fuel, this being exceptional-
ly true where the heating of the feed water can
be accomplished by the use of exhaust steam or
by utilizing the heat by the waste gases. A feed
water filter is also desirable to eliminate scale
and sediment forming elements from the feed
water.
All traps should be examined to see that they
operate properly and do not leak. Many instances
are found where traps are wasting hot water to
THE MODERN HOSPITAL
439
the sewer, when this water, and especially its
heat, might be saved. All hot surfaces should be
thoroughly insulated. The pipe covering should
be kept in repair. All flanged joints should be
covered. No hot surfaces, whether carrying
steam, condensation returns, drips, or hot water,
should be uncovered in any portion of the plant.
For the hot-water supply of the building, stor-
age heaters should be provided. Automatic ther-
mostats controlling the temperature of the water
should be provided. The distribution of the hot
water from the hot-water tanks to the fixtures
in the building should be by means of a circulat-
ing system, and the hot-water tank and all hot
water piping should be covered with asbestos.
Proper coal and ash handling equipment should
be provided to lessen the labor of the operating
force, so that more attention may be given to the
economical operation of the plant.
EFFICIENCY DETERMINATIONS
Relatively few hospital plants are equipped
with devices which make possible the determina-
tion of the efficiency in operation. Only by the
use of fuel and water measuring instruments can
a correct determination of the efficiency of a plant
be had. Every pound of coal and water fed to the
boilers should be measured.
Reliable coal scales are a most essential ele-
ment in every plant, but without means of meas-
uring the water the results obtained from fuel
burned are at best a matter of guess. The water
fed to the boilers may be measured by means of
Lea Feed Water Recorder or Venturi Feed Water
Meter, or steam flow meters may be applied to
the main boiler connections. In large plants the
use of steam flow meters in the main supply and
the different departments is highly desirable.
In this connection, the uniform feeding of boiler
with both coal and water is most desirable.
With the quantity of coal fired and water fed
to the boilers known, a simple calculation deter-
mines the amount of water evaporated per pound
of coal and roughly determines the efficiency of
the plant, for a more exact determination of the
temperature of the feed water and the heat value
of the fuel should be determined, the former by
a reliable indicating or recording thermometer,
and the latter by an analysis of the fuel by means
of a bomb calorimeter. The former is warranted
in all plants, and the latter in large plants. For
small plants, an analysis of the fuel can be had
in many commercial laboratories. The value of the
draft gauge has already been mentioned. It is
often desirable also to determine the temperature
of the waste gases. In addition, an analysis of
the waste gases is emphasized by many authori-
ties and is highly desirable in large plants. The
percentage of carbon dioxide present in the waste
gases gives a very clear indication of the effici-
ency of the fuel combustion.
All the data obtained from the intelligent use
of these instruments should be written systemat-
ically on a specially arranged log sheet and a
daily calculation should be made to determine the
efficiency of the plant. The result of this calcula-
tion may helpfully be plotted upon a sheet, show-
ing the progress made in increasing the efficiency
of plant operation.
PLANT OPERATION
In the operation of the plant, proper fuel selec-
tion and intelligent operation will inevitably bring
about the best results. Just at this time, the
proper selection of the fuel is a difficult matter,
but its intelligent use is most essential. Low-
priced labor in the boiler and engine room is al-
ways most expensive. Skilled service, even
though at high wages, is always most economical.
Nothing should be permitted to interfere with
the principal duty of the chief engineer, which
is the proper supervision and economical opera-
tion of the heating and power plant, and daily re-
port as to the results of the plant operation should
be required of him. He should be held responsi-
ble not only for the operation of the plant, but
also for its maintenance, for the upkeep of re-
pairs, and for the appearance of the plant. The
prevention of leaks and wastes should be most
rigidly insisted upon, this applying both to the
heating and plumbing system.
Experts in the economical operation of power
plants should be employed to consult and coop-
erate with the operating force of every large
heating and power plant. The proper selection
and installation of the instruments herein refer-
red to are not sufficiently understood by the aver-
age operating engineer. Neither is that use of
these instruments which will promote maximum
efficiency in plant operation thoroughly under-
stood. To both should be applied the judgment
of thoroughly experienced designing and operat-
ing consulting engineers. Patriotism and self-in-
terest urge zeal and promptness in these matters.
The Merchants' Association of New York City, in a
letter sent by its Committee on Pollution and Sewerage
to Director General William G. McAdoo of the U. S. Rail-
road Administration, urges the installation of suitable
sanitary devices in railroad trains to protect water
courses adjacent to railroad rights of way from contami-
nation by the discharge of the contents from train water-
closets. The use of a "sealed closet" is recommended,
and it is believed that its installation on cars built during
government control of the roads would be inexpensive.
Those who can take the lead are given the lead. If
they neglect this opportunity, theirs is the responsibility
for the failures which must ensue. — Arthur T. Hadley.
440
THE MODERN HOSPITAL
Fig. 1. Administration building
front of the Koberto del Rio childr
THE HOSPITALS AND THE HOSPITAL SYSTEM OF CHILE '
A Highly Centralized System, in Which Private Charity Is Administered Under Govern-
ment Control— Hospitals o£ Santiago, Valparaiso and the Provinces
—Schools for Nurses and Midwives
By M. K. CHAPIN, Managing Editor of The Modern Hospital, Chicago
The hospitals of Chile appear to be organized
on a plan which presents some rather interesting
and, to people in this country, unfamiliar fea-
tures. In theory, at least, Chilean hospitals are
apparently not regarded as functions of the state.
They are favorite objects of private charity. We
are told, for instance, of the prevalence in the pro-
vincial city of Antofagasta of the admirable cus-
tom of honoring persons deceased, not by perish-
able funeral wreaths, but by gifts to the local
hospital' ; and a similar practice seems to be not
unknown elsewhere in Chile, for, here and there
among the records of substantial bequests and
donations, running up into hundreds of thou-
sands, to hospitals in various places, appear such
items as the gift of 940 pesos (about 340 dollars)
from the medical society of Concepcion to the
children's hospital of that city in honor of the
recently deceased Dr. Roberto del Rio. Again,
we read that, a certain hospital being about to
close its doors for lack of funds, a private citizen
(a candidate for the senatorship, by the way) in
that province came forward with the offer to pay
its expenses out of his own purse.'-
Few Chilean hospitals, however, are autono-
mous private institutions. Of the 108 hospitals ex-
isting in the republic in 1915, all but 7 were con-
trolled by local quasi-governmental boards of
charities (juntas de beneficencia) ; and these local
boards were in 1917 placed under the control of a
superior council of public charity (Consejo Super-
ior de Beneficencia Publica). Thus the hospitals
are under a highly centralized form of control.
•This article
in the Revista
Sup(
notes refer to th
this periodical.
> Cronica, March, 1918. IT, 1.
= Cronica, September, 1917, I, 95
' Cronica, September, 1917, I, 93
collective alwtract. drawn from articles contained
Beneficencia Publica. the orRan of the Consejo
de Beneficencia Publica of Chile. All of the following foot-
w. The accompanying illustrations are from
The principle on which these local boards were
originally organized was supposed to be that of
independent subsistence on their own individual
funds, together with the contributions of charity.
The proportions contributed by the central gov-
ernment and by the municipalities, however, have
increased from year to year until the juntas de
beneficencia have been transformed from private
institutions into public services, maintained
chiefly from government funds.^ Of the 8,528,-
043.58 pesos (about three million dollars) spent
by the hospitals in 1915, 4,165,959.66 pesos, or
nearly half, was contributed by the central gov-
ernment ; 66,752.59 pesos was given by the munic-
ipalities; 443,384.10 pesos came from private do-
nations; and 3,813,877.23 pesos was the income
from the property owned by the juntas de bene-
ficencia themselves.^ Although the constitution
and the law require the municipalities to main-
tain charitable institutions, they are unable to
fulfill this obligation unless aided.=^
In August, 1917, the president of Chile issued
a decree establishing a superior council of public
charity intended to unify the action of the various
local boards, to advise the government with re-
gard to the distribution of public funds and the
plans offered by the departmental juntas, to draw
up a plan for the organization of the services,
etc.''' The members of this central council are
chosen in part by the national government and in
part by the local boards. The council publishes
a quarterly review, the Revista de Beneficencia
Publica, on information contained in the various
numbers of which this article is based.
■■ Santelices, R.. Philippi. J., and Gormaz, J. M. : Los Impuestos a
Favor de la Beneficencia. November, 1917. I, 293.
^ Philippi, J. : Discussion, October, 1917, I, 158.
" Creacion del Consejo Superior de Beneficencia Publica, September,
1917, I, 90.
THE MODERN HOSPITAL
441
GENERAL VIEW
The 108 hospitals existing in 1915 offered a
total of 10,395 beds, of which 9,468 were free and
927 for paying patients. The hospital provision
for men consisted of 5,778 beds, and that for
women, of 4,617 beds. The total personnel con-
sisted of 36 resident and 364 non-resident physi-
cians, 19 pharmacists, 539 nuns, and 2,954 em-
Santiago, the capital, possesses, in the Hospital
de San Juan de Dios, the oldest hospital in the
country, whose foundation in the middle of the
sixteenth century dates back to the conquest, or
at least to the conquistador es. The Junta de
Beneficencia de Santiago, founded in 1819, is like-
wise the oldest of the local boards, besides being
the most active (it organized the first congress of
Fi.. 2. Ground floor plan oi the proiected 425^bedchiM,.n^s hospital in^S^^^^^^^^
?Sr?o'™frs"rfthl s'^aua"re'by\pe^ ^illtries ^tic'S''p^.^°t"f f ree cljc^ulXn of air in tL court within. The western building (lower side
of cSt^fs the administratis building with a lecture ampitheater back of the reception rooms The southern side (right of cut) is de-
ot cut) IS tne aaministration Duuaing wiiu i '"; ,. ^-.tl „ section for infectious d seases. The north side contains the surgical poly-
clinic ind warts^with f s«tion for- infanrs*^ "^li'e ea^t sidt ftop of cut) contains the morgue and laboratory of pathologic anatomy, the
kitchen laundnf; rnddfnin^^ooms for the personnel, with rooms for the sisters, nurses, and servants above. The scale on the plan
represents 20 meters (about 65 feet).
ployees.= The death rate of Chile is high (29.04
per thousand)' and this hospital provision for a
country of over two million inhabitants is very in-
adequate.
R.: Hospitales Especiales para In-
the various juntas de beneficencia in 1917) and
the most influential (it sends two members to the
superior council, whereas the other juntas send
but one each). Besides the Hospital de San Juan
de Dios, the Santiago board controls eight other
hospitals with a total of between three and four
442
THE MODERN HOSPITAL
thousand beds, an orphan asylum, an asylum for
the insane, and an extensive and important out-
patient system, with nine dispensaries attached
to hospitals and six operated independently. Two
of the large hospitals for children, the Manuel
Arriaran and the Roberto del Rio, are noticed
later on in this review.'
One of the first endeavors of the Consejo Su-
perior de Beneficencia Publica was to find out the
actual hospital situation of this country. A hos-
pital survey was accordingly made of Valparaiso,
which is estimated to have about two hundred
thousand inhabitants, and is the city next in size
after Santiago. This survey shows five hospitals
with a total of 1,343 beds, including beds for aged
persons and chronic and infectious cases, under
the control of the junta de beneficencia of that
city. This is regarded by the author of the sur-
vey as a thousand beds short of the needs of the
city, which is the most important seaport in Chile
and consequently receives through immigration
and emigration more than its share of cases of
sickness."
Except in Santiago and Valparaiso, the hos-
pitals lack most of the modern facilities for diag-
nosis and treatment. For instance, it is said that,
in a city of twenty thousand inhabitants, the first
appendicitis operation was recently performed in
the only hospital, which as yet had no operating
room.^'' Because the provincial hospitals are
without diagnostic laboratories and installations
for radiotherapy, mechanotherapy, electro-
therapy, etc., well-to-do patients generally go to
The court and gallery of the build
children's hospital, Santiago,
completed.
Santiago for treatment, and charity patients, if
their cases are difficult, are sent there at the ex-
pense of the local junta de beneficencia or by pub-
* VicI, V. B.: Speech before the Prime
Publica, October, 1917, I, 133.
■* Deformes, E. ; El Problema Hospitalari'
1918, n, 201.
10 Gomez, V. ; Plan de Fomento de loa Hospitales Depax-tmentales
December, 1917, I, 396.
Congreso de Beneficencia
en Valparaiso, September,
lie subscription." This puts a heavy strain on
the hospital facilities of the capital.
MATERNITY HOSPITALS AND THE TRAINING OF
MIDWIVES
Experience in the United States furnishes no
grounds for surprise at finding obstetrics a re-
latively neglected branch in Chile. Taking the
country as a whole, the proportion of maternity
Fig. 4. Waiting room of the polyclinic of San Juan de Digs, Val-
paraiso.
beds to population is 1 to 8,500, and there are
groups of three and four provinces each which
have not a single maternity hospital among them.
Those which do exist are said to have inade-
quate attending staffs and insufficient facilities
for isolating infectious cases, for care of feeble
and premature infants, and even for sterilizing
water and dressings. Moreover, it is current prac-
tice to refuse treatment to a pregnant woman in
any other than the obstetric service, and to sep-
arate the obstetric from the gynecological serv-
ice.'=
Midwives form a recognized part of the staff
of maternity hospitals, and one of the complaints
against the present maternities is the insufficient
number, not only of physicians but also of mid-
wives. A school for midwives (Escuela de Ob-
stetricia y Puericultura para Matronas) is con-
ducted under the auspices of the medical school
of the University of Chile, at the Hospital de San
Borja, Santiago. The course is two years in
length and instruction is free. The requirements
for entrance are age over eighteen and under
thirty, good health, good moral character, and
five years' schooling. Resident and non-resident
pupils (called interns and externs) are received.
Each province except Santiago and Valparaiso is
allotted an internship, and the candidate is re-
^^ Guzman : Creaci6n de Hospitales, December, 1917, I, 403.
•= Miinckeberg, C, Espic, J. E., and Montt, M. G. : Maternidade» y
Hospitales, November, 1917, I, 248.
THE MODERN HOSPITAL
443
quired to give bonds amounting to 1,000 pesos
(about $360) that she will practice her profession
in her home province for three years after gradu-
ation. In the four years from 1914 to 1917, in-
clusive, the school has graduated 110 midwives."
children's hospitals and child welfare
This subject appears to be one of much interest
in Chile, if one may judge by the cities of Santi-
ago and Valparaiso. The former city has under
construction one large hospital of 374 beds for
children, the Manuel Arriaran. The accommoda-
tions will comprise 162 beds for genei-al internal
medicine, 50 for infectious medical and sui'gical
diseases, 116 for general and special surgery, and
46 for nurslings." Plans are shown for enlarg-
ing another children's hospital, the Roberto del
Rio, to a capacity of 425 beds.'"'
Santiago has several societies devoted to child
welfare. One, composed of women, the Sociedad
Protectora de la Infancia, gives medical and other
relief. Another, composed of men, the Patronato
del Infancia, maintains a little asylum with fifty
beds for mothers and a hundred for infants. Here
mothers are received with their infants on dis-
charge from the maternity hospital, cared for
temporarily, and helped to make a new start in
life; here also are taken children whose mothers
are in hospitals.'" Ten "gouttes de kit" stations
(Gotas de Leche) are maintained in Santiago, and
the Gota de Leche has been successfully intro-
duced into almost all the cities of the republic.
Still another society, the Ollas Infantiles, is un-
dertaking to furnish meals to undernourished
school children.
Valparaiso has a private hospital for children,
^^ Earros, J. R, : La Escuela de Obstetricia y Puericultura para
Matronas de la Universidad de Chile. March. 1918, II. 19.
1* Commentz, A. : El Hospital de Ninos Manuel Arriaran, Santiago,
September. 1917, I, 14 ; June, 191S. II. 154.
'= Jequier, E. : El Hospital de Niiios Roberto del Rio, September,
1918, II, 231.
" Instituciones Privadas de Beneficencia, September, 191S, 11, 328.
Valdes Valdes, I. : El Problema de la Infancia, September, 1918. II. 267.
eighty-five beds for children in the public general
hospitals, and an active Sociedad Protectora de la
Infancia.'"
OTHER special INSTITUTIONS
Tuberculosis Hospitals. — Santiago has one in-
stitution devoted to tuberculosis, the Hospital de
San Jose, which in 1916 received 2,744 patients."
Valparaiso has two, with a capacity of 218 beds,
the Hospital del Salvador, for chronic tubercu-
losis, and the Sanatorio de Pefia Blanca, for cur-
able cases.^ Tuberculosis is very general in Chile,
and the mortality is high. It is estimated that
over 70 per cent of the population is tuberculous,
and nearly 29 percent of the deaths in Santiago
are due to this disease. Soza'* believes that 10
percent of the available hospital beds should be
devoted to tuberculosis.
Hospitals for Other Communicable Diseases. —
Isolation pavilions for the care of communicable
Fig. 6. A pupil in the School for Nurses. Santiagro, showin:.? the -worl
ing uniform (now temporarily discontinued owing to war-tim
prices of materials) and case for equipment.
diseases are lacking. Vaccination against small-
pox is not compulsory in Chile. Infectious dis-
eases contribute largely to the mortality.'"
1' Lindsay. O. : La Sociedad Protectora de la Infancia de Valpa-
raiso. September, 1918. II, 273.
^* Soza, E. ; Hospitalizacion de los Tuberculosos, December, 1917,
I. 445. T H
1" Cadiz, M., and Edwards, C. R. : Hospitales Especiales para
Infecciosos, November, 1917, I, 207.
444
THE MODERN HOSPITAL
Hospitals for the Insane. — The Casa de Orates
de Santiago shelters over 1,900 patients of all
classes and grades — acute and chronic, curable
and incurable cases, epileptics, idiots, cretins, im-
beciles, senile dements, alcoholics, and criminals.
The need of a system of psychiatric hospitals and
institutions for different classes of mental disease
or defect is emphasized.^"
NURSING AND NURSING EDUCATION
The profession of nursing was officially estab-
lished in Chile through the foundation in June,
1906, of the state school for nurses. The course
is two years in length, and includes theoretical
work, taken in the morning, and practical work
in the hospitals during the afternoon. A uniform,
modeled on that used in the United States, had
been adopted, but the outbreak of the present war
doubled the cost of the materials and caused its
discontinuance.-^
The part played by members of the religious
sisterhoods in the conduct of the hospitals makes
it necessary that the sisters should understand
nursing. Accordingly, in 1917 courses of instruc-
tion for the sisters were established in the Santi-
ago hospitals del Salvador, San Borja and San
Juan de Dios. In the Hospital de San Jose, where
twenty beds have been set apart for purposes of
instruction, the sister superior has endeavored to
modify the habit worn by the sisters to make it
more suitable for nursing.--
In general, the cure of the sick would appear to
be at least partially in the hands of attendants
(cuidadores, veladores) whose duties and status
are not defined in the sources of information
available.
HOSPITAL STANDARDIZATION
Chilean hospital administrators are very eager-
ly and earnestly seeking standards on which to
model the organization and administration of
their institutions. The hospital standardization
movement in this country is apparently being fol-
lowed with lively interest in Chile. A rather full
abstract of the hospital standardization meeting
of the American College of Surgeons appears in
the Revista de Beneficencia Publica,-^ and the re-
viewer remarks, "The authoritative pronounce-
ment of the Chicago committee is a powerful re-
enforcement of our opinions." One characteristic
shared by the various writers in the Revista
seems to be a sincere desire to see their own pres-
ent hospital situation in the light furnished by
the best achievements of Europe and America.
Chile is apparently working out her own hospital
problem.
AFTER THE WAR— WHAT?
-"del Campo, M.: El Problema de la Hospitalizacion de los Enajena-
dos, November. 1917. I. 317. Lea-Plaza. H., and Fontecilla. O. : El
Problema Nacional de la Hospitalizacion de los Alienados, November
1917. I. 397.
-'Lira, E. D. : La Escuela de Enfermeras de Santiago, June, 1918,
n. 126.
22 Car\allo. C. V., and Lira, E. D. : Organizacion del Servicio
Medico Auxiliar, December. 1917, I. 343.
*■'* Amunategui, G. : Normalizacion de los Hospitales, March, 1918,
II. 41.
The Return of the Hero and What It Means — Prospect
and Retrospect
In other days, the old soldiers' home was a shelter for
the seemingly helpless and a harbor for the inefficient idle.
The name itself, says Callie Hull, writing in the Voca-
tional Summary, is reminiscent of the beautifully kept
roomy house, with its multitude of benches, on which the
heroes of the past sat idly all day long, whittling uselessly
at broken twigs, poring over the thumb-worn pages of
old magazines, or smoking away the hours which hung so
heavily on their hands. Evening brought the supper-bell
and the long lines of cripples, with empty sleeves, stump-
ing wooden legs, or sightless eyes, who came together at
the long table for the common meal. After that, gather-
ing shadows and darkness — and all were off to dreams of
days gone by — days when, with strong bodies and active
minds, they had faced the world as men, before the sac-
rifice of hope, home, work, success, and their very all. A
place of idleness and inactivity, clouded with the atmo-
sphere of retrospect, filled with the "broken bodies and
stagnant minds of men who had read over the door at the
time of their entrance the fact that their lives had already
been lived — that was the old soldiers' home of the days
gone by!
The future will not repeat the past. It will be "the
home of the soldier" rather than "the soldiers' home."
Reconstruction will be individual rather than institu-
tional. To each returning soldier, the nation will extend
a cheery welcome, in the assurance that nothing will
remain undone to help him find himself and to equip him
for a place in the industrial world — a place which will
not be donated to him through a sense of gratitude and
charity, but one which he will hold by sheer force of his
own ability and fitness. After the best of medical atten-
tion, training will be given him, either in a new vocation
suited to his disability or in more extensive study which
will better equip him to resume the old. Workshops will
be open for instruction, colleges will offer courses in agri-
culture, mechanics, engineering, clerical work, etc., and
factories will extend a welcome hand in the matter of
training. Everywhere the returned soldier will find that
the right of way is his.
The future does not face a "home" set apart at a safe
distance from the sphere of industrial activity. Rather
it sees "homes," scattered about everywhere, in the large
cities, the smaller towns, and the broad expanse of farms,
just as they were in the days before the call of war had
sounded through the land. And to each, in the evening,
will return a man who, in spite of physical handicaps, is
holding his place in the industrial life of the nation. The
fact that a missing limb has been replaced, that an eye
no longer sees, or that an ear has been deafened forever
will not make any less cheery the welcome which awaits
him from the woman at the gate or the child who toddles
down the street to meet him. For the bell at evening
will call him, not to an institutional board, but to his own
table, where he will talk of the things that are, rather
than of those that were, and of the work that lies ahead,
rather than that which was ended when the war began;
and, while his wounded body will bear, perhaps, the scars
of battle, his active mind will look, not backward on the
remains of a life that has been ended, but forward to the
hopes of a life that is still to be lived.
THE MODERN HOSPITAL
THE WAR-TIME ECONOMY PROBLEM IN THE HOSPITAL*
445
Best Results Obtained When Spirit of Patriotism Is Urged Amon^ Employees— Ways of
Solving the Labor Problem— Keeping Hospital Up to Full Capacity
Greatest Single Economy— Quantity Buying Unpatriotic
By THOMAS ALAN DEVAN, M.D., Assistant Superintendent, Peter Bent Brigham Hospital, Boston
THE subject of economy in hospital administra-
tion, important at all times, is especially so in
war-time. The practice of economy has long been a
studied art with hospital superintendents, but the
fact that the government has requisitioned labor
and supplies on such an extensive scale has made it
necessary that the whole field of hospital man-
agement be gone over anew with a view to institut-
ing further economies. When some hospital es-
sentials have advanced 200 per cent in price
within two years and the former scale of wages
has been entirely discarded, it behooves us to
attempt to inculcate a habit of economy among
all hospital workers.
The campaign for economy, at all times unpopu-
lar, is, in these war-time days, less so than for-
merly. When the plea for economy is put upon a
patriotic basis, it is heeded the more readily. The
public press has aided greatly in putting people in
a frame of mind to listen to arguments for econ-
omy. From the standpoint of hospital administra-
tion, every means of fostering the patriotic spirit
throughout the hospital household should be en-
couraged. Employees should be urged to invest
in Liberty bonds and war saving stamps; the
bulletins of the Food Administration should be
posted ; and short talks to the nurses and help on
the scarcity of gauze, thermometers, and crockery
should be periodical — all to the end that the war
may be made real and personal to each hospital
worker. It is in this way that we can make each
one interested in the practice of economics. The
doctor or nurse will not save gauze unless inter-
ested in saving it ; the kitchen-men will not save
grease unless interested in saving it. When these
measures are urged as patriotic duties, they re-
ceive greater attention.
The study of economy in war-time is the same
elusive study it has always been. It is the same
close attention to the labor requirements of a
situation, the same exercise of careful judgment
in the purchase of supplies, and the same diligent
tracing of the course of supplies through the in-
stitution that it always has been.
GENERAL HOSPITAL ECONOMIES
1. The labor shortage is outstanding. It is an
interesting and significant fact that the hospital
•Read before the Twentieth Annual Convention of the American
Hospital Association, Atlantic City, N. J.. Sept. 24-28, 1918.
is one of the few organizations all of whose
trained and experienced personnel is urgently
needed by the war machine. Doctors, nurses,
orderlies, pharmacists, technicians, and ambul-
ance drivers — all are war essentials in the military
sense. Because of this, very soon after the out-
break of the war, hospitals had to curtail activities
wherever possible. One of the first places to feel
the pinch was the research laboratory. Research
work has necessarily suifered. We all know how
much time and money were devoted to research.
We also know how much research work was under-
taken, which, from the outset, could have only
a most remote usefulness. At present, however,
little research work is carried on, and none should
be sanctioned which has not a fair prospect of
useful results, since for no other pieces of research
work can the expenditure of time and money be
afforded.
Because of the shortage of male help, women
have been employed wherever possible. At the
Peter Brigham Hospital women are employed to
tend the steamtable in the serving room, to oper-
ate the utensil-washer in the kitchen, as night
cook, as night switchboard operator, as pharma-
cists, and even as ambulance drivers— all to re-
place men. One hastens to remark that not all
of these represent wage-saving on the part of the
hospital, because these women are frequently paid
as much as men formerly received, though not as
much as men at the present time would have to
be paid. But it represents a saving of the man-
power of the country by just so much. Some hos-
pitals have found it impossible to obtain ward
maids and have been forced to have this work
done by the nursing force. We have not been
forced to change back to the twelve-hour tour of
duty for nurses and are not thinking of doing so.
We have admitted to the training school larger
classes than in pre-war days, and it is probable
that we will have to use senior pupils in increasing
numbers as head nurses. The Peter Brigham
Hospital has derived slight benefit from women
volunteers. We have made use of some volunteer
workers in the social service department, in the
library, on the wards as nurses' aids, and for
short intervals in our pharmacy. But volunteers
for wa" work prefer to get in more direct contact
with the military forces than the average hospital
can supply.
446
THE MODERN HOSPITAL
2. An important general measure of hospital
economy is to have the hospital take care of as
many patients as it possibly can. While we, as
hospital executives, have our attention focused
so largely on economical measures of purchasing
and conserving supplies, we are likely to lose sight
of the fact that a hospital running at half its
patient capacity is a ship with its cargo space but
half filled. How can this be controlled? Per-
haps we cannot expect a full hospital all the time,
but we can adopt one or two measures to help keep
the beds full. The most important measure is to
insist that the admitting officer get into the habit
of mind of accepting cases whenever possible.
The writer believes that many admitting officers
often seek reasons for rejecting patients. The
admitting officer must make the family physician
and the patient feel that he is cooperating with
them to accept the patient and not take the atti-
tude that the doctor much furnish good and suf-
ficient reason why the patient should be accepted.
He must not study up technical grounds upon
which he can safely reject patients ; he must make
it his practice to admit whenever possible. If the
surgical beds are full and the medical service has
empty beds, transfer convalescent surgical pa-
tients to medical wards and accept new surgical
patients. This will not please the physicians, but
they can have small grounds for complaint; for,
if they cannot fill their own wards, then these
wards must be filled for them.
3. It is recognized that a great deal of time and
money is wasted in the way in which patients tour
from one hospital to another. A duplication of
records and a wastage of x-ray plates and labora-
tory supplies, to say nothing of the time of the
doctors and nurses, always results when a patient
goes aimlessly from one hospital to another for
the same complaint. Occasionally this is neces-
sary to obtain particular opinions. But is it not
our duty to urge the patient to return to the hos-
pital where first treated or to bring a letter from
that hospital, stating the reasons why it is desir-
able that the patient be admitted ? If the govern-
ment were to assume control of hospitals, as has
been done in the case of colleges, perhaps this
repeating process could be controlled. Indeed,
such a sweeping war change would result in many
important economies.
4. Shall the hospital, as a matter of war-time
economy, do quantity buying in the face of pros-
pective higher prices? This is a question which
has been answered in the negative at the Peter
Brigham Hospital. It is our general policy not
to buy extensively for future needs, because we
do not consider it patriotic to do so. Heavy buy-
ing tends to produce just the shortage which the
government is striving to avoid. Furthermore, if
one buys for future needs, there is practically no
point short of the limits of the treasury where
he may stop. Every ardent salesman tells us that
the commodity in which he is interested is to be
advanced in price 10 per cent or 20 per cent next
week or next month. As no article, except those
the prices of which the government has fixed, is
exempt from this upward tendency, there is no
limit to the list of articles which we are advised
to store away. The two or three exceptions to
our general policy have been on butter and eggs.
We have put into storage about four months'
supply of each of these necessaries. After all,
should not the hospital stand on its own footing
and seek, along with everyone else, its chance of
procuring supplies as they are needed? We be-
lieve it should. In connection with the question
of quantity buying comes that of centralized buy-
ing. This has been tried out thoroughly enough
through the Hospital Bureau and other agencies
to have established its usefulness on a sound basis.
Rapidly advancing prices render it especially im-
portant and profitable to make use of contract
agreements such as these agencies have in force.
Moreover, it is a great economy of time, because
one knows that the contract price represents the
bottom market price. It is a war-time economy
to make ever increasing purchases through a cen-
tralized agency.
SPECIAL HOSPITAL ECONOMIES
Among the numerous separate items of hospital
economy which may be mentioned are the follow-
ing:
1. In an institution where gauze is "recov-
ered," it is perhaps more economical to purchase
a 24-20 grade gauze instead of a lower count, inas-
much as the better gauze at a cent or cent-and-a-
half increase in price can be washed perhaps five
or six times, while the lighter weight will stand
but three washings. Also, on the wards, for ex-
tensive urological drainage cases, a Bethune pump
is found to save gauze greatly. Paper bandages
and absorbent pads, "cellucotton," and sphagnum
moss are passably satisfactory as substitutes for
gauze and cotton. Where one has access to a good
cotton-picking machine, the most economical and
satisfactory method of overcoming the cotton
shortage is to have old white rags picked over
into cotton. At the Peter Brigham Hospital we
have had to buy almost no cotton since installing
a cotton picker. This picked cotton is very ab-
sorbent ; in fact, it is so satisfactory as absorbent
cotton that the institution now buys no absorbent
cotton, so-called. At present we have just about
enough white rags to supply our needs as cotton.
THE MODERN HOSPITAL
447
2. Our consumption of glycerine has been cut
ifl half by excluding its use from a mouth wash
extensively used on the wards and limiting its
use in enemas. Similarly, absolute alcohol is no
longer used at the Peter Brigham Hospital.
3. When a gas-ether apparatus is used for
anesthesia it is important to have some one who
will be responsible for seeing that all valves are
tight. A leakage here is a leakage in the ex-
chequer.
4. In pre-war times, enamel urinals were not
used at the Peter Brigham Hospital. Poor glass-
ware has been the rule for the past year or so,
and recently we have installed enamel urinals for
all "precaution" cases, as the glass ones would
not stand sterilizing without breaking. A con-
siderable saving has resulted.
5. The suggestion is made that, as a matter of
hospital economy, two lectures on the costs of
hospital supplies be inserted in the curriculum of
the training school for nurses.
6. Until recently, bath blankets at the hos-
pital were sent to the laundry after being used
once. Now each patient has a set of two bath
blankets. These are kept in his bedside table and
are changed once a week. This procedure has
reduced the number of bath blankets passing
through our laundry by 50 percent.
7. Turkish toweling is now purchased by the
yard and made up in the sewing room. Allowing
for all costs, it is estimated that we save just the
difference of one grade of toweling.
8. Perhaps the dietetic department has seen
more modifications due to war exigencies than
any other. This is doubtless due to our effort to
keep up with the regulations of the Food Admin-
istration. But these regulations frequently do
not point in the direction of economies. Nowa-
days, however, we find ourselves purchasing or-
anges of considerably higher counts, veal in larger
amounts, cattle of lighter weight, less beef, and
prunes of much smaller size, than formerly.
Every other week, fish can be served on three,
instead of the customary two, days. Tripe, liver
and tongue are served more frequently than form-
erly in an effort to follow the directions of the
Food Administration. Merged butter is used at
some institutions. We agree with those who be-
lieve that coffee can be enhanced in flavor by the
addition of a little chicory, and this permits the
purchase of a lower-priced but satisfactory cof-
fee. Our very limited experience with egg pow-
ders and milk powders has not been encouraging.
The labor shortage has brought about the adop-
tion in some hospitals of a cafeteria system of
serving nurses and help. A great economy of
food and labor is claimed for this system, as well
as a great saving of dishes. In most serving
rooms, the employment of war-help has resulted
in a greatly increased bill for replacing crockery.
At the Peter Brigham Hospital a new dish-washer
recently broke $22 worth of dishes in one week.
It is probably poor economy to get a cheap man
at this post.
9. In the wards a very appreciable saving of
food has resulted from urging the nurse to study
carefully the dietetic requirements of her patients
and not to serve them twice the amount she
knows they will eat. We have observed the
shrinkage in our garbage as a result of this meas-
ure.
10. It is interesting to note that, in the na-
tion-wide food conservation campaign, so little
has been said about the destruction brought about
by rats and mice. Yet it is even more important
than ever in these days of soaring prices to at-
tack these ever-present pests. In our experience,
the careful distribution of poison has been most
eflicacious. One person should be made strictly
accountable for its distribution, care, and final
collection.
11. A word about the war-garden. We believe
that, unless the hospital has considerable land at
its disposal or unless it can make use of patient
help, a war-garden is not an economy. All that
can be said for it is that it helps to stimulate the
habit of economy throughout the hospital and
that it fosters the patriotic spirit. As a saving
of money, the war garden fails.
12. For one hospital extravagance we have
yet to find a good remedy, and that is, prodigality
in the use of hot water. Close attention to faucets
and the adoption of automatic shut-off valves,
such as are in use on some laundry machines, may
check a little of the wastage, but how much flows
on to the sea! Possibly the hot-water service
could be shut off from some buildings for a por-
tion of each day. For the coming winter, in the
face of another coal shortage, we should look to
economy in electricity as well as in hot-water
service. Then too, we must conserve heat. Last
winter we closed up a great many doors and win-
dows for the season. It was surprising the num-
ber of places we found we could close up without
interfering with ventilation. This, together with
a "close-the-door" campaign, resulted in a con-
siderable conservation of heat.
13. Probably in these brisk war days, time-
and labor-saving machines are especially econom-
ical, even though the machines themselves have
gone up in price. We have recently installed
some additional machines in the laundry. The
work of the laundry cannot proceed faster than
the capacity of its slowest machine. If there be
448
THE MODERN HOSPITAL
a backing up of the work before the extractors or
the dryers or the presses, the appropriate remedy
is indicated. This sounds simple, but at the Peter
Brigham Hospital such a backing up had appar-
ently existed for many months without its be-
coming known. It is, therefore, the part of econ-
omy to see that all the working parts of the
laundry are evenly coordinated.
SUMMARY
By way of summary, one can say that war-time
economies are pre-war economies intensified.
They mean the subordination of all the hospital
activities to the chief essential of caring for pa-
tients and training nurses. They mean, too, the
adoption of broad policies, such as the policy of
attempting to make the war real and personal to
each hospital worker in order that he may be in-
terested in economizing ; the policy of striving to
keep every bed full; the policy of fostering cen-
tralized purchasing; and the master policy of
eternal vigilance.
Abstract of Discussion
Mr. Daniel D. Test, Philadelphia: I have called the
doctors, the nurses, and the employees together separately,
about once in three months, and I have talked over the
problems of the cost of material and the very great dif-
ficulty that we have in getting money to pay our expenses.
The added cooperation even of the cleaners in using soap
has been a very large saving, and it has brought about a
new spirit of cooperation and loyalty. They like the idea
of having the superintendent come and talk to them.
After careful investigation we find that the use of a
24-28 grade of gauze is much more economical than the
one that was recommended here, 20-24.
HOSPITAL ACCOUNTING
Detailed Allowances and Expenditures of Departments Shown from Month^^to Month by
Expense Analysis Value of System in Stopping Leaks-
Benefits of the Budget System
By CHARLES A. PORTER and HERBERT K. CARTER, of the Staff of The Modern Hospital
tConiinued from November issue, p. 375]
EXPENSE ANALYSIS AND BUDGET
SYSTEM
EXPENSE ANALYSIS
THE Charge Register shows the departmental
expenses in a general way. Headings are
given in this book for the principal groups of ex-
penditures, as heretofore explained, so as to facil-
itate the transfer of the individual expenditures
to the Expense Analysis sheets.
The Expense Analysis (Form 22) is for
the purpose of showing the detailed allow-
ances and expenditures of the departments in such
a manner that comparisons from month to month
and for the previous period and year may be
made. It also shows how the expenditures of each
department are to be distributed.
A sheet is made out for each department as
follows :
1. Administration.
2. Wards.
3. Private rooms.
4. Emergency ward.
5. Dispensary.
6. X-ray.
7. Laboratories.
8. Social service.
9. Ambulance.
10. Housekeeping.
11. Steward's department.
12. Laundry.
13. Training school.
14. General house and property.
15. Heat, light, and power.
16. Corporation.
The following examples show in detail how
these sheets are made out :
Form 22. Expense Analysis. Above, left-hand Page; below, nght-hand page: with binding margin to be added at right-hand and left-hand side.,
respectively. Actual size, 19% by 1114 inches.
THE MODERN HOSPITAL 449
EXAMPLE No. 1— ADMINISTRATIVE
jj Appropriation Expense Expenao Expense
'o"" present period to Bttmc period
month month date last year
Controllable expense:
Salaries and wages —
Superintendent and assistants $ g « «
Purchasing agent
Clerks .......... ..[...[... .......... .........
Supplies —
Stationery $ g 5 §
Printing
Miscellaneous.
Telephone and telegraph-
Telephone service
Operators' salaries. . . .
ToUs
Telegraph service
Legal expense
Furniture and fixtures. . .
Miscellaneous expense. . .
Total controllable expense.
Uncontrollable expense:
Corporation expense
General house and property.
Total .S.
Charge percentage to wards
Charge percentage to private rooms
Charge percentage to laundry
Charge percentage to dispensary
Charge percentage to general house and property. .
Charge percentage to ambulance
Charge percentage to training school
Charge percentage to x-ray
Charge percentage to steward's department
Charge percentage to housekeeping
Charge percentage to emergency ward
Charge percentage to social service
Charge percentage to laboratories
Total (as above) ?
Note. — All of the expenses of the Administrative Department are charged to departments by
percentages determined by the Superintendent and his assistants.
EXAMPLE No. 2— WARDS
Appropriation Expense Expense Expense
Item for present period to same period
month month date last year
Controllable expense:
Salaries and wages —
Head nurses $ S $ $
Nurses
Dietitian
Etc
Etc
Etc
SuppUes —
Medical
Surgical
Furnishings
Miscellaneous
Total controllable expense S S ' S
450 THE MODERN HOSPITAL
Uncontrollable expense:
Charge from administration
Charge from steward's department
Charge from housekeeping
Charge from general house and property.
Charge from laboratories
Charge from x-ray
Charge from laundry
Total *• ^ * ®
Number of patient days treatment S
Cost per patient per day
Analysis sheets for emergency ward, social service, dispensary, and private rooms are made
out in this same vi^ay.
EXAMPLE No. 3— X-RAY DEPARTMENT
Appropriation Expense Expense Expense
Item for present period to same period
month month date last year
Controllable expense:
Salary of operator $ S 8 $
Salary of assistants
Supplies:
Plates
Tubes
Miscellaneous
Total controllable expense
Uncontrollable expense:
Charge from administration
Charge from housekeeping
Charge from general house and property.
Total expense
Charge percentage to wards.
Charge percentage to private rooms. . .
Charge percentage to emergency ward.
Charge percentage to dispensary
propriation
Expense
Expense
Expense
present
period to
same period
month
month
date
last year
Total (as above) S
The sheets for the laboratories, ambulance, training school, housekeeping, and laundry will be
made out very nearly like the above example.
EXAMPLE No. 4— STEWARD'S DEPARTMENT
Item
Controllable expense:
Salaries and wages — ■
Salaries for supervision
Cooks
Scullions
General kitchen help
Miscellaneous
Dairy products —
Milk
Cream
Buttermilk
Cheese
Eggs
Butter
Meat, poultry, and fish —
Beef
Mutton
Pork
Ham
Poultry
Game
Fish
SheUfiah
THE MODERN HOSPITAL 451
Groceries and provisions —
Flour and cereals
Bread and crackers
Coffee, tea, cocoa, aiid chocolate.
Yeast, baking powder, etc
Confectionery and ice cream ....
Sugar, molasses, and syrups
Etc
Fruits and vegetables —
Potatoes
Carrots
Apples
Oranges
Etc
Miscellaneous —
Ice
Table Water
Coal
Supplies
Repairs
Total controllable expense $.
Uncontrollable expense:
Share of administrative expense $.
Share of general house and property
Total expense
Charge percentage to administration
Charge percentage to wards
Charge percentage to general house and property.
Charge percentage to private rooms
Charge percentage to emergency ward
Charge percentage to dispensary
Charge percentage to social service
Charge percentage to ambulance
Charge percentage to housekeeping
Charge percentage to laundry
Charge percentage to training school
Charge percentage to x-ray
Charge percentage to laboratories
Total (as above) .
EXAMPLE No. 5— GENERAL HOUSE AND PROPERTY
Appropriation Expense
for present
month month
Expense
Expense
period to
same period
date
last year
Controllable expense:
Salaries and wages —
Mechanics
Elevator runners
Etc
Repairs —
Furniture and fixtures.
Elevators
Etc
General supplies
Total controllable expense
Uncontrollable expense:
Heat, light, and power
Charge from administration
Charge from steward's department.
Insurance
Taxes
Rent
Miscellaneous
Charge for depreciation
Total expense .
452
THE MODERN HOSPITAL
Charge percentage to administration
Charge percentage to wards
Charge percentage to private rooms
Charge percentage to emergency ward
Charge percentage to dispensary
Charge percentage to x-ray
Charge percentage to laboratories
Charge percentage to steward's department.
Charge percentage to laundry
Charge percentage to training school
Total (as above)
EXAMPLE No. 6— HEAT, LIGHT, AND POWER
Appropriation
Expense
Expense
Expense
for
present
period to
same period
month
month
date
last year
Controllable expense:
Salaries and wages —
Engineers
Firemen
Supplies —
Fuel
Oil
Waste
Miscellaneous .
Repairs
Total controllable expense
Uncontrollable expense:
Charge from administrat on
Charge from steward's department.
Total expense $
Charge to general house and property.
The following illustration will show the value
of this book :
The Superintendent, in looking over the Ex-
pense Analysis, discovers that the amount spent
for rubber sheeting is in excess of the monthly
allowance and more than was allowed for a cer-
tain period. It is plain to be seen that purchases
of this article on such a scale will exceed the Bud-
get allowance before the expiration of the year.
It is an easy matter for him to make an investiga-
tion to determine the cause of these excessive pur-
chases, and make the curtailment necessary to
conform to the allowance of his Budget.
The Expense Analysis furnishes the means of
locating excessive expenditures in any depart-
ment.
The first step in stopping a leak is to find its
location. It is a part of the purpose of this book
to locate these leaks, so that the Superintendent
may apply the proper remedy.
The Expense Analysis also furnishes a basis
from which to estimate future needs of the insti-
tution. It is from the data furnished by these
sheets that the Budget is made up.
THE BUDGET
The Budget is a list of estimate needs for a
given period based on a record of past expen-
ditures.
-TK MODERN HOSPITAL
BUDGET FOR 1917
Form 23. Budeet. Actual size, 16 by UVi inches. Bound book, with binding margin to be added at left-hand side
THE MODERN HOSPITAL
453
The usual method of preparing a Budget is to
make a list of the past expenditures of each de-
partment for a given period and estimate the com-
ing requirements by the future policy of the insti-
tution as approved by the Governing Board.
The Expense Analysis gives a comprehensive
record of past performances, but this is not suffi-
cient in making up a Budget. There are other
factors to be considered. The advance or decline
in prices of supplies and material, additions to
the institution, or any change of the administra-
appropriation, if any, for the current year, and
the expenditures for the past year. The expendi-
tures from July 1 to December 31 during the past
year and from January 1 to July 1 of the current
j'ear, and the totals of the two, are shown in sepa-
rate columns. This enables the executives to see
at a glance the expenditures of these periods.
In municipal hospitals the Budget system is
almost universally used, and, as a rule, they must
live within the bounds of their appropriation.
Private and quasi-public institutions will find the
SuperirXenden-Cs Report fo Treasurer for Monih of /?/ ,
Dn. 1. ill/per I'ntcr^inTs Aocounf tftth Tre^asuRE r Cn
Total, i^rom Prenuui /rfonrh^
Total, ^rcrn prf^ytous ATanffjs
Crana Total d/rrc^r Bxpcnja
Hospital E.ifnini:,i
Ca/o/ral E x^AncJi^-ti/re-s
Cash /'i-cm Trea!,i,reLr
Balance,
Tciral
Total,
Z. Expenses from SpeciaZ Fi/nds <5t/perintenden{:'-i -S, Trial Salance ¥. 8ala/vc£ S^£:£t
F
Cai^
U
Accai/nts Re^f-irab/e.
_
5;;^^
TL
■4
^.w.
n
/^aTcnal
7
D
Si'-'^J y^,<,fl, Tr-COi
5
A^^a-^oe Paut! by Pa-fi'a^^
0> e^/pay^er^r^ ^t; ^f/c^^s
0 r^,,L^'rri£.a /^'^qe^
Acccfnr^ Pau^/y/^
Sc-i-fL ' fr^
D.iCC^nrs
TorAi.
TcTAU
1
Form 24. Superintendent's Monthly Report. Actual
12 by 9 inche.'!.
tive policy likely to affect the revenue or expenses
of the institution should be taken into account.
The importance of a comprehensive record of
past expenditures can be appreciated in prepar-
ing a Budget. A properly kept Expense Analysis
means the difference between a guess and an esti-
mate in making future plans for an institution.
The Expense Analysis (Form 22) is de-
signed for an institution using the Budget sys-
tem. It will be noted that a monthly expense al-
lowance is made for each department. This esti-
mate is copied from the Budget.
The Budget as shown (Form 23) is designed
to present the request for the coming year, the
Budget system to be not only a benefit in antici-
pating expenses, but, if referred to at stated
periods, will notify the management through the
Expense Analysis when their expense are ex-
ceeding their appropriation. By being served
with this advance notice, the administrators are
enabled to solicit funds before bills are accumu-
lated, before discounts are lost, and before the
efficiency of the institution is hampered by a lack
of a sufficient working capital.
The summary sheets of the Budget and an ex-
ample of the sheets from the various departments
will be shown in succeeding chapters.
[To be continued.]
454
THE MODERN HOSPITAL
LITTLE JOURNEYS TO PLACES AND PEOPLE WORTH KNOWING
The Sixth Little Journey— To the Nurses' Home of Mount Sinai Hospital, New York
—Every Effort Made to Give the Best of Nursing Education
and Home Life to Pupil Nurses
By MARGARET J. ROBINSON, R. N., Field Editor, The M dern Hospital, Chicago.
THE standards of Mount Sinai hospital need no
description or introduction. The hospital was
established in 1852 and at that time had a bed
capacity of 28 patients. When its new buildings
and various departments are completed it will
have a capacity of 750 and will be, with one ex-
ception, the largest voluntary hospital in the
world.
Nurses in training at Mount Sinai may have
contact with ninety thousand patients in a year
in the hospital and dispensary services. Over
a thousand nurses have graduated from this
school. A large percentage of them occupy posi-
tions of responsibility in the nursing field. To
have graduated from Mount Sinai is a mark of
prestige for any young woman in the nursing
profession.
The school maintains about two hundred nurses
at present and thirty-six supervising graduates,
exclusive of those in the social service depart-
ment. A registry for graduates has over three
hundred nurses on its list ; more than four thous-
and calls for their services were received during
the year of 1917.
Special arrangements have recently been made
whereby women from approved colleges and uni-
versities will receive a credit of nine months on
the three years of training in the school. A
number of scholarships are awarded to nurses
in training. These scholarships include one of
$500 for a course in the department of nursing
and health of Columbia University, New York,
recently established by the president of the train-
ing school, and a number of annual awards of
$100 in gold to students for excellence in scholar-
ship, deportment, and bedside nursing.
These scholarships serve a threefold purpose.
In the first place they give, in some cases, an
actual financial assistance to ambitious young
women who need more funds to carry them
through their training ; secondly, they are an im-
pulse towards finer scholarship and a greater de-
votion to detailed practical work in the school,
and lastly they encourage more student nurses
towards further post graduate nursing education.
There are several other capitalized funds for
the use of the school. One, known as the pleasure
fund, provides for theater parties and dances in
the winter months, and has purchased the best of
victrola records. A library fund furnishes news-
papers, current magazines, current literature and
reference books. A sick nurses' fund sends sick
Fig. 1. Probationers' study hour
THE MODERN HOSPITAL
455
Fig. 2. A class in practical
and weary nurses for needed rest under proper
and happy conditions. One fund provides for the
renovation and new and attractive furnishings
for the home.
Even the bouquet of orchids and lilies of the
valley worn by the superintendent of the train-
ing school at commencement time and the violets
tied with purple ribbon worn by the graduating
class are given by a generous-hearted trustee.
Other men from this very human and kindly
board of directors and their auxiliaries furnish
the big Christmas tree and candy and gifts, and
concert and theater tickets and moving picture
shows.
The nursing section of the Mount Sinai Base
Hospital unit No. 3, now in service in France,
was formed in the training school. This unit is
complete in its supervision and personnel and
was recruited without thought of the sacrifice of
the hospital. The staff, hospital, and training
school gave their best. On January 15, 1917,
there were twenty-one enrolled Red Cross nurses
in the list of graduate assistants ; sixteen of these
were released for army service.
The educational advantages of the school of
nursing are as good as can be secured. The
hospital fortunately has sufficient funds to meet
all the requirements of present day methods of
nursing education, an administration which be-
lieves thoroughly in advanced nursing education,
and a competent force for the supervision and in-
struction of the training school.
Miss Elizabeth Greener, the principal of the
school, has the complete cooperation of the officers
of the training school board, and of Dr. S. S.
Goldwater, the director of the hospital, in all
things which will tend to advance the best meth-
ods of nursing education, the health protection
and social welfare of the nurses in training.
The training school has scientific and practical
laboratories for instruction in pathology, bac-
teriology, materia medica, and dietetics. There is
thorough nursing instruction in medicine, surgery,
pediatrics, anatomy, chemistry, nursing ethics,
principles and practice, obstetrics and gynecology,
special practice and social welfare.
A demonstration room constantly adds to its
furnishings and equipment anything and every-
thing necessary to practical and thorough demon-
strations in nursing art and practice. This room
contains various supply closets, plumbing, beds,
and practically all the material needed in daily
use for the care of patients. All junior classes
of student nurses receive thorough instruction
here before they are permitted to take part in the
direct care of patients.
To meet the present great need of nurses, as
large classes as the school capacity will accommo-
date are being admitted. In September of this
year there were fifty-eight entered, in three sec-
tions, in order to avoid the confusion which might
occur ■:! the handling of so large a number of pro-
bationers at any one time. The first group con-
sists of twenty pupils for the regular three-year
456
THE MODERN HOSPITAL
course; all are high-school or college graduates.
The second group will be the first section of the
Vassar School of Nursing students, twenty in
number, all graduates of the college. The third
group will be the second section from the Vassar
school.
When I visited the nurses' home of the Mount
Sinai Hospital I came out into the wide entrance
hall just as the night nurses were reporting for
duty, all ready to go over to the hospital to take
up the work where the day force left it. They
were a pretty sight, trim and orderly and cheer-
ful. A little later the day force returned to the
home, strolling in by twos and threes, and soon
the great cheerful living room at the left of the
hall was filled with friendly groups.
The great size of the room and the large num-
ber of student nurses in it didn't seem to detract
from the homey atmosphere of the place at all.
A beautiful picture hung over the wide mantel
shelf. On one wall was a tapestry of wonderful
weave and coloring ; on another were unobtrusive
frames holding original letters written in faded
brown ink, one a discharge from the army of
the United States, signed "George Washington,"
in the midst of it all, girls everywhere, young and
pretty and light-hearted, and sedate and studious,
all in spotless blue and white. May God love
them all and bring them trained hands and heads
and luck and happiness !
At the desk in the hall was the house mother,
the nurses' chaperon and social companion, a
charming gray-haired woman, a graduate nurse,
who looked thoroughly the part she was there to
play. Behind her was a roster board with col-
ored wooden pegs which showed at a glance where
each nurse was at the time. One color meant
that the nurse whose name was underneath was
on duty in the hospital, a peg of another color
showed that she was off duty or on vacation or
ill or taking her maternity training in another
hospital.
The duties of the house mother are numerous,
and all necessary in the scheme of things to pro-
tect and mother the girls in the home. She is on
duty from six o'clock in the evening until two
o'clock in the morning. She greets the day nurses
when they come to her desk to change the keys on
the roster board. She directs the new arrivals
and sees that thev are made comfortable. She
Fig. 3. The demonstrating room. Bed-making.
and the other an officer's commission, signed
"Abraham Lincoln."
The picture of the room was completed by
big comfortable lounging chairs and settees, a
grand piano and victrola, soft shaded library
lamps, a huge floor rug of vivid coloring, and
gives out the permissions for late leave and
checks them when the nurses return to the
building.
The house mother receives the visitors, and
when ten o'clock comes, arranges for the closing
of the house and the noiseless return of those
THE MODERN HOSPITAL
457
who have had a good time outside of the building.
At eleven o'clock she makes rounds, and knows
that each nurse is accounted for, and visits the
roof, too, to see her children who are sleeping out
of doors. Then she returns to the main floor and
The serving of the night supper is only one of
the illustrations of the spirit in which the nurses
at Mount Sinai are cared for, and the thorough-
ness with which everything is planned for their
training and comfort.
Fig. 4. A comer cf ihe
waits until all the nurses on duty have had their
supper.
At two o'clock, if all is w^ell, the house mother
goes off to bed, and the night supervisor takes
charge and after that the night watchman goes
about every so often to see that all the children of
the house are safe from harm.
A night housekeeper is on duty in charge of the
serving of night suppers to the interns and nurses
and employees of the night force. She has to
assist her a cook and waitress and a porter.
The night supper served is a real meal and not
a light lunch. It consists of hot meat and vege-
tables and all that goes with them. Things are
so arranged that everyone on duty is relieved for
this meal. The service begins at 10:30 p. m.
Attractive trays are serviced to nurses on duty
on isolated cases. Over three hundred nurses of
the school and fifty to eighty special nurses are
served in the dining room during the twenty-four
hours. The dining room is cheerful and well
cared for. On the side walls the brackets with
electric candle fixtures have yellow silk shades on
them, which soften and mellow the general effect.
The officers, the directors, and administrators
of the Mount Sinai Hospital are of a race
which as a rule does things well. Their hos-
pitals in this country, wherever you find them,
from San Francisco to New York and from
Canada to the Gulf, are efficiently managed and
stand distinct among themselves for a broad
charity. To these men the home is part of their
splendid religion. To them the education, the
happiness and protection of the young girls in
training are vital things. They are worthy of
their trust.
Eugenics in Brazil
There is a eugenic society in the enterprising city of
Sao Paulo, the first to be organized in that country. The
object is frankly to improve the race and render it
worthy of so grand a country. The subjects to be covered
in this connection are the laws of heredity, the propaga-
tion of knowledge of eugenics and hygiene and the spread
of education in general. This plan of instruction aims to
inform the public as to the harm wrought by syphilis,
alcoholism, tuberculosis, etc. Other activities are regula-
tion of prostitution, prenuptial examination, and all steps
which will diminish the birth rate of de.^enerates, idiots,
etc. It is to be hoped that this patriotic movement will
be taken up by other Brazilian states. — Brazil-Medico.
458
THE MODERN HOSPITAL
Hit. I. Recreation hall of Sheppai.l and Enoch Pratt Hospital.
FROM OUR FIELD EDITORS' NOTEBOOKS
Two Mental Hospitals Where Occupational and Diversional Therapy Are Used— Study of
Diversional Therapy at Sheppard and Enoch Pratt Hospital -Wide Variety of
Occupations at Kalamazoo State Hospital
Sheppard and Enoch Pratt Hospital, Towson, Baltimore
There are few hospitals which enjoy a mere beautiful
situation than Sheppard and Enoch Pratt. The buildings,
scattered over the extensive grounds on the wooded hills
just outside of Baltimore, have more the aspect of a
country estate than that of an institution for the care
of the mentally disordered. As in many public parks,
the trees and shrubs bear labels on which are printed
plainly, in each case, the common and botanical name.
This work, however, was done, not by the gardeners, but
by a patient, who, though ignorant of botany when she
took up the task as a labor of love, has herself gained
mentally and physically and has also added to the pleas-
ure of other patients.
Dr. Edward N. Brush, the superintendent, is a strong
believer in the therapeutic value of occupation in mental
disorders, and a wide variety of handicrafts are practiced
by the patients for their value in diversional therapy.
Dr. William Rush Dunton, Jr., assistant physician at
Sheppard and Enoch Pratt, is known to all who are inter-
ested in occupational therapy, through his publications
on the subject and his activity in the National Society
for the Promotion of Occupational Therapy. The tele-
phone operator at Sheppard and Enoch Pratt, by the way,
is a blind girl, who is said to perform her duties very
acceptably. The switchboard work of an institution is
said to be very suitable for the blind, who are subject
to fewer distractions than workers who can see.
Dr. Brush has promised The Modern Hospital an
article on the work which can be done by an endowed
hospital for mental patients in moderate circumstances.
The Kalamazoo State Hospital (Mental)
The industrial reeducation and instruction in the arts
and crafts in the Kalamazoo State Hospital, Kalamazoo,
Mich., show very definitely the therapeutic value of these
methods in the care of the mentally ill, and, although the
work is always considered primarily for its therapeutic
value, it has proved to be one of the greatest factors in
the efficiency and the economic administration of this state
institution.
1
i
i
^J^HME^^iKIb|^a^|
^^^■^1^ ^^mf ''^^ '--mai
j^^~ -■■'-^..
^|Eii<iiiiifiHrn'"^'HMlM
^^H
^^^^^^^^^^^^msf-^ri^sSt^^^^
HIHI^fl
foreground, to the rlfht). with the
and the women's building at the left.
superintendent's
the distance (center),
THE MODERN HOSPITAL
459
The patients are carefully and scientifically graded,
both as to their previous social and industrial condition
and as to their mental and physical capacity. They are
given something to do, something to think about, and, if
their cases are capable of improvement, their minds ar^
led, as a child's would be led, from the kindergarten to a
higher grade, and then still higher, until at last they may
gradually find themselves again.
Women patients who were so low in the mental scale
that they had to be shown how to braid rags in order to
learn to braid their own hair have been patiently and
gradually taught to make beautiful things that any of us
would be glad to have in our homes, with the result that
both their mental and physical strength has grown while
they were doing it.
Reclamation is considered everywhere in the industrial
building, and nothing is wasted that can be used again.
Hats for the patients and the employees who do the farm
work are made here, from the unraveled straw matting
which comes around chests of tea. Socks which refuse
further mending when they come from the laundry are
unraveled and woven into socks again.
Old clothes, beyond all hope of mending and repair, are
cut up into rags and woven into attractive and durable
rugs. The benches on which the workers sit while weav-
ing are made by other patients in the carpenter shop.
The two hundred and eighty-five rugs needed to furnish
Fig. 4.
of the working pa-
in the upholstery department are made all the mat-
tresses used in the hospital, and chairs and couches are
upholstered. Part of these rooms are given over to looms
which weave canvas and a very good gn'ade of linen
toweling, made from the flax which is also spooled here.
Solid and artistic chairs and tables for use in tiie insti-
tution and all furniture repairs are made in the cabinet
maker's room, and cane seating done. The patient who
is most expert in caning learned the trade here.
In the cannery, where a machine makes the tin cans
used, are put up the fruits and vegetables grown by the
A dairj' worker and
of hts animals.
the new building added to the hospital for attendants'
quarters have all been made in the weaving room.
Laundry bags are woven, fish-net fashion, out of heavy
cord. Waste burlap which comes into the storerooms
around bags and packing cases is woven into brown rugs,
and decorated with artistic designs by using thrums, the
mixed wool waste of different colors which is sorted out
into the separate colors, spooled, and woven into the rugs
by the patient students. The thrums are used, too, for
warp and woof. On Donegal looms they make really
beautiful window curtains and draperies for use in the
hospital buildings, the kind that would cost a goodly sum.
In another room a number of women patients were
running motor sewing machines and making their own
aprons and dresses. Some were able to sew only the
straight seams, but there were others who had advanced
far enough to cut and fit the clothing. The pieces of the
blankets destroyed by excited patients are quilted together
and covered with canvas. This makes an indestructible
blanket to use for violent eases.
In the shoeshop, new shoes are made and the shoes
worn by patients and employees are kept in order as long
as they are worth saving. A master-tailor supervises the
work done in the tailor shop, and this is one place in the
industrial building where some trade knowledge on the
part of the patient is an absolute necessity; men who
have had no previous experience can do only the very
simplest work here.
farmer patients. In this way the patients and employees
may have better grade of canned goods and more of them
than the institution could otherwise afford to give them.
The hospital has its own farm and its own daii-y, and
under the supervision of a skilled farmer and a skilled
dairjTnan, the work is all done by the patient.s who are
best suited by experience, or who need out-of-doors work,
and great improvement has resulted.
The end-results of the industrial reeducation show 33
percent of improvement in patients who can undertake the
work and 22 percent discharged from the care of the
hospital.
Fig. 5. Laying pav
460
THE MODERN HOSPITAL
M035E1W eOSPITAL
EDITORIAL AND PUBLICATION OFFICE.
58 East Washington Street, Chicago.
EDITORS.
Henry M. Hurd .
Frederic A. Washbi
Winford H. Smith
S. S. Goldwater
W. L. Babcock
John A. Hornsby
Fidelity Building, Baltimore
ass. General Hospital, Boston
Hopkins Hospital, Baltimore
. . Mt. Sinai Hospital. New York
Grace Hospital, Detroit
58 East Washington Street, Chicago
Johns
M. K. Chapin
MANAGING EDITOR.
58 East Washington
Street, Chicago
SUBSCRIPTION.
Domestic postage, $3.00. Foreign postage, $3.50 (15
Shillings). Single copies, 35 cents.
Domestic rates include United States, Cuba, Mexico,
Porto Rico. Canal Zone, Hawaii, and Philippines.
Contributors, subscribers, and readers w
portant information on advertising page 42.
Z¥5Z3
mm
Our Opportunity in Belgium
If the nations to which remains only the breath
of life in a few broken or starving bodies can
spend that breath in giving thanks for deliver-
ance, what should be the thanksgiving of this
nation — still rich, pow-
erful, unscathed by the
horrors of inv^asion, and
lightly touched by the
suffering and loss of
war? Should it not
take the form of a
thank-offering ? We owe
to those countries that
bore the brunt of the
war a debt which it will
take us long to repay.
Particularly do we owe
an immeasurable debt
to the little nation
whose epic stand held
back the German war
machine for six fateful
weeks and saved the
day for Western civili-
zation.
"What can America
do after the war by way
of beginning to pay the
debt of gratitude she
A Merry Christmas? The blood-stained
page has too lately closed. Except to
children and the thoughtless, merriment
will return but slowly. A joyful Christ-
mas— the most memorable the world has
known for many centuries — this we can
celebrate with thankful hearts before we
turn our faces toward the New Year
and the beginning of that future which
we have glimpsed hitherto only through
rifts in the battle smoke — that future
whose significance it will take us per-
haps years to grasp. The new day
means the realization of some of hu-
manity's age-long dreams — it does not
mean the pleasant ease of old. Courage,
ardor, vision, and self-denial — if we
needed these in the dreadful times that
are past, we shall need them ten-fold
more in the soul-searching times before
us. If you will have a wassail toast, let
it be : To the great days to come ! May
we rise to their measure!
owes Belgium?" This question was addressed by a
member of the staff of this magazine to Captain
Dr. Rene Sand, official delegate from Belgium to
the meeting of the American Medical Association
last summer. When Captain Sand's reply was
published in The Modern Hospital only two
months ago' one scarcely dared to think of the
time when we might claim the privilege of help-
ing Belgium — after the war.
"The first few months of peace," wrote Cap-
tain Sand, "will decide our future fate ; either we
shall slip down to haphazard ways and hasty,
patched-up solutions, or we shall rise to a system
of competence, efficiency and constructive reform.
At that moment our convalescent nation will need
material help, personal help — nurses, social work-
ers— and advice.
"We could imagine no greater service to our
country and no better way of perpetuating the
brotherhood which has grown up between both
nations than a permanent American foundation
in Belgium. Its triple purpose would be to foster
research, to offer information on reconstruction
problems, and to maintain an educational cam-
paign aimed at raising the standards of life in
Belgium."
As Captain Sand points out, ravaged Belgium
has yet a rare — perhaps a unique — opportunity —
the opportunity to make a fresh start. Rightly
used, this means possibly the achievement of
progress that might have been unattainable on
the basis of the past. For the United States to
be invited to participate
in this fruitful experi-
ment is a high honor.
Is it not also a great
privilege for the hos-
pital profession to do
its share — which
should be an important
one — in the working
out of this great idea?
What pride and satis-
faction might we not
feel in seeing Belgium
the experiment station
of civil ization — the
seed plot wherein an op-
portunity for germina-
tion might be afforded
to promising reforms
which find no room to
unfold in the overgrown
soil of other countries!
Would not this be a
'Sand, Ren4: How America Mar
Help Belgium After the War, Oc-
tober, 1918, XI, 256.
THE MODERN HOSPITAL
461
magnificent opportunity to make health what it
should be, the cornerstone of the social edifice, and
to build a hospital system from which should radi-
ate enlightenment and health education for the
people? We could scarcely ask a greater privilege
than to be associated in such a work.
How could this be accomplished? That is for
Belgium to tell us. The first step which The
Modern Hospital would like to see taken would
be the formation of an American commission to
study the Belgian situation and to learn the needs
and aspirations of the Belgians. The members of
the commission should be practical men — and
women — for it must not be forgotten that, in a
country which has lost so many of its men, women
must perforce play an important part in recon-
struction. They should be practical people, we
have said, realizing meanwhile that he who is
called the dreamer may be the most practical man,
and that among the most practical qualities for
a commission of this kind are sympathy, tact,
constructive imagination, and infinite patience
with and interest in the problems which its mem-
bers are to study. It is not time yet for
organizers and administrators; indeed, the best
administrators in the world might be the worst
possible choice for such work. This is a task
which calls for the open mind rather than the
practised hand.
If the idea is once given responsible sanction
and entrusted to suitable commissioners to carry
out, opportunity should be afforded to the Ameri-
can people to contribute toward the expense
of its fulfillment. It should be the pleasure, as
well as the duty, of every American citizen to
give for this purpose according to his means.
We should be not merely paying a portion of our
debt, but also taking advantage of a golden oppor-
tunity to do constructive work which, in the end,
would surely be for the benefit of the whole world,
ourselves included.
Some Advantages of Institutional Membership*
When the new plan of organization for the
American Hospital Association was discussed at
the Atlantic City meeting, it became evident that
its advantages required some explanation. "I am
a member of the association," said one and an-
other superintendent in effect ; "when I attend its
meetings, I represent my institution; when I go
home, I give my hospital the benefit of what I
have learned during the sessions. What do we
gain by acquiring institutional membership?"
Possibly there was even a positive misunderstand-
ing— a feeling that institutional membership was
•The Bulletin of the American Hospital Association, page 472,
further describes the institutional membership plan, and nnfo 71
of the advertisement section contains an application blank.
page 71
a device to get more from the hospitals, rather
than a means whereby the American Hospital As-
sociation might render its members more efficient
service. The suggestion that hospitals would
find it to their own advantage to take out insti-
tutional membership even seemed to arouse a cer-
tain resentment, the impression evidently being
that this advantage would be secured only by dis-
criminating against those hospitals which had
not institutional membership. It is therefore
worth while to study carefully the actual bearings
of the plan.
Institutional membership is going to put the
association in a position to render services worth
many times the institutional membership fee —
services which the hospitals need now and are
going to need more and more as time goes on.
The weight and authority of the association will
be increased, and it will be able to exert greater
influence before state and national legislative
bodies, if it can display credentials as the official
representative of the hospitals, its constituent
members, than if it appears merely as an asso-
ciation of individuals connected in various capaci-
ties with the hospitals. Now, in the reconstruc-
tion times ahead of us, the financial and other
interests of the hospitals are going to constitute
a serious problem, demanding study of the inci-
dence of taxation and of legislation aflfecting hos-
pital welfare from other points of view. An of-
ficially accredited spokesman will be able to com-
mand consideration and avert ill-considered leg-
islation which might prove disastrous to the
hospitals.
If the hospitals come to the support of the plan,
the proceeds from the institutional membership
fee, wisely used, will enable the association to give
the smallest of its constituent members expert
service the cost of which would be prohibitive to
the individual hospital. The benefits of this ex-
pert service will accrue proportionately more to
the small, weak institution than to one that is
large and prosperous. Let us suppose, for in-
stance, that the increased revenue from institu-
tional membership fees permits the association to
engage, on annual retainers, high-grade legal
counsel, an equally high-grade hospital consultant,
and a publicity expert. Then, if a hospital at
Jenkins Four Corners or Last Chance wishes to
know its liabilities under the terms of a contract
or its rights as a beneficiary of a will, it will have
the right, as a constituent member, to bring the
problem before the association and to receive an
authoritative opinion, the monetary value of
which may be many times the cost of institutional
membership. Again, the same hospital has per-
haps been running behind in spite of the best ef-
462
THE MODERN HOSPITAL
forts of the superintendent and staff. An expert
opinion is needed as to the treatment necessary
to put it on its feet. A competent hospital con-
sultant would charge $100 a day and expenses.
The Jenkins Four Corners hospital can not pay
anything like that sum. Application to the
American Hospital Association, however, brings
out the possibility of having the association's hos-
pital consultant make a tour of inspection of the
Jenkins Four Corners hospital and four or five
others on the same route, at a cost to each hospital
only of its proportionate share of the consultant's
traveling expenses. Let us further suppose that
one of the hospital consultant's findings is that
the community does not understand the hospital
or the service the hospital is prepared to render,
and hence does not support it. A publicity cam-
paign is indicated. The superintendent's train-
ing qualifies her to run the hospital, but not to
advertise it. Professional "promoters" are costly
and of dubious value. The American Hospital
Association, however, will furnish, without cost,
attractive publicity material, prepared by its pub-
licity expert for use in local newspapers. Or, if
it is desirable to base a publicity campaign on the
local situation, the association's publicity expert
will plan such a campaign at nominal cost.
These are merely a few illustrations of the
otherwise unattainable benefits which hospitals
might secure through a properly financed asso-
ciation. Others will readily suggest themselves
— a laboratory for testing hospital supplies, an
information exchange, etc. Experience will sug-
gest many other ways of effective cooperation
through the medium of the reorganized associa-
tion.
How many of these benefits will accrue to the
hospital world at large, without distinction of
membership? A great many of them; certainly
there should be no attempt to confine them to
members by discrimination against non-members.
The association is bound to lose the very weight
and influence which constitute the chief reason
for institutional membership if it allows itself to
become the representative, not of American hos-
pitals as a whole, but merely of hospitals which
see fit to pay ten, twenty-five, or fifty dollars for
their respective institutional memberships.
Rather, it should be the effort of the association
to work for the good of the hospitals without
regard to membership — to make non-member hos-
pitals feel that the American Hospital Associa-
tion is their friend, with their interests at heart.
What, then, are the inducements to institu-
tional membership? Why should not a hospital
remain an outsider if it can, without paying a
membership fee, derive many of the benefits from
the reorganized association? That difficulty, we
believe, will take care of itself. Hospitals will
naturally be reluctant to ask the help of the asso-
ciation on their individual problems unless they
are making the association some return for the
service. When the value of the service is far in
excess of the membership fee, it will be strange
if many hospital boards hesitate after having
the advantages of membership pointed out to
them.
Finally, the individual hospitals are going to
profit greatly by the increased attention to hos-
pital affairs which institutional membership will
demand of hospital boards, and the consequent
promotion among trustees of interest in and
knowledge of the principles which should guide
hospitals and the standards by which they should
be judged. Today, too often boards of trustees
have no clear idea of the work and needs of the
institutions with which they are connected or of
their own relations with these institutions. One
board may consider its duties ended with the rais-
ing of money for ends of which it has no clear
conception ; another may, through motives of mis-
taken economy, hamper the most valuable activi-
ties of the institution ; and a third may interfere
disastrously with the superintendent's manage-
ment. Trustees may approve or disapprove the
work of the superintendent without having any
true criterion for such judgment. Institutional
membership should be the means of bringing
boards of trustees into closer relationship with
their respective hospitals, so that they may be
prepared to cooperate more efficiently and intelli-
gently with the superintendents. It should be-
come general practice for trustees, as well as for
superintendents, to inform themselves of the
trend of hospital progress by attending the meet-
ings of the American Hospital Association.
These trustees are generally able, progressive
business men, who need only an insight into hos-
pital principles to become most valuable aids to
hospital progress. With their interest thoroughly
aroused, the success of the American Hospital
Association and of the individual hospitals is as-
sured.
The War Industries Board and Hospital Supplies
We are requested by the section on medical
industry of the War Industries Board to give pub-
licity to several announcements which are of in-
terest to hospitals.
It is suggested that the prospects for securing
needed surgical supplies are now very much im-
proved if the hospitals place their orders through
the usual channels. For the guidance of the gov-
ernment, hospitals and physicians are urged to fill
THE MODERN HOSPITAL
463
out and return to the board inventories of their
probable needs for the next six months, with indi-
cations of the articles that are difficult for them
to secure.
The United States Railroad Administration has
suggested that, in order to avoid congestion of
transportation during the winter, hospitals as-
semble their supplies as early as possible. If any
freight agent questions a hospital's right to have
needed articles shipped, his attention should be
called to circular C. S. I-A issued by the car serv-
ice section, division of transportation. United
States Railroad Administration, dated March 26,
1918. The present embargo by the American
Railway Express Company is confined to ship-
ments weighing five hundred pounds or more. If
an express shipment of more than five hundred
pounds which is desired for emergency purposes
should be refused by the express company, state-
ment of the fact should be made to Lieut.-Col.
F. F. Simpson, chief of the section of medical in-
dustry of the War Industries Board. An effort
will thereon be made to adjust matters satis-
factorily.
The platinum section and the section of medical
industry of the War Industries Board express ap-
preciation of the hearty response made by physi-
cians, dentists, and others to the call for scrap
platinum. The governmental demand for plat-
inum for making of explosives has been tremen-
dously decreased in accordance with the curtail-
ment of war activities, and it is therefore re-
quested that no further scrap platinum be ten-
dered to the government.
The Hospitals of Chile
Chilean hospitals became part of a unified sys-
tem somewhat less than a year ago, and Chile
seems in a fair way to work out a national hospital
policy. This achievement is apparently the nat-
ural result of conditions widely different from
any with which we are familiar. A country with
a property-owning class, small but dominant, by
virtue of intelligence and education, over a large,
illiterate, and hopelessly indigent laboring class,
natui'ally tends toward centralization. Add to
this the fact that our neighbor to the south has
but a single religious denomination to reckon with,
and one may begin to appreciate some of the
reasons for unfamiliar phenomena.
Chilean medical and hospital men are citizens
of the world — eager and interested students of the
progress of events in Europe and America. Their
familiarity with people and institutions in the
United States is rather surprising. The proceed-
ings of the American Hospital Association, the
American Medical Association and the American
College of Surgeons are cited by writers in the
official organ of the central council which controls
the Chilean hospitals; the book by Hornsby and
Schmidt on "The Modern Hospital" and the ar-
ticles on the community hospital by Miss Barrett
and Miss Jordan, published in this journal, are
quoted as authoritative; and the Mayo Clinic, the
Massachusetts General Hospital, the Ohio Valley
General Hospital, Mount Sinai Hospital of New
York, the new Bethany of Kansas City, and the
Robert Packer of Sayre, Pa., are mentioned as
exemplary.^
As will be seen by the article on the Chilean
hospital system which appears on another pageS
these Chilean writers are keen critics of their own
hospitals, which they do not hesitate to judge by
the standards of the most advanced institutions
elsewhere. (It is interesting to note, by the way,
that when it comes to institutions for the insane,
they find the most recent and the most advanced
example of the agricultural colony for incurables,
not in Europe or America, but in Buenos Aires,
Argentina, which has a large and well-organized
"Open-Door" colony.) =^
Their criticisms, however, are not destructive
or pessimistic. Every review of existing con-
ditions is followed by practical suggestions for
improvement. The pages of the Re vista de
Beneficencia Publica abound with outlines for
model hospitals of fifty or a hundred beds, plans
for the organization of dispensaries and out-
patient services, plans for the organization of
first-aid services in small cities, etc. The Chileans
are convinced that the health conditions in their
country form a serious obstacle to its progress;
hence the energy with which they are addressing
themselves to the solution of these problems.
Centralization has its advantages as well as its
disadvantages, and it may very well be that Chile
will furnish some very interesting developments
in the organization of hospitals and public health
work.
Our Relations with Latin America
One of the duties which the United States must
prepare to assume after the war is that of de-
veloping our natural relationships with the rest
of the world and particularly with our neighbors
in the Americas. We have not yet entirely freed
ourselves from a certain provincial — not to say
parochial — self-centeredness, which we must
shake off" if we are to play our allotted part in
the reconstruction of the world after the war.
^ Guzman, \, : Creacion de Hospitales, Rev. de Benef. Pub., Decem-
her. 1917, I. 403.
- Chapin. M. K. : The Hospitals and the Hospital System of Chile, p. 438.
s del Campo, M. : El Problema de la Hospitalizacion de los Ena-
jenados. Rev. de Benef. Pub., November. 1917, I, 317. Lea-Plaza, H.,
and Fortecilla, O. : El Problema Nacional de la Hospitalizacion de los
Alienados, ibid., 327.
464
THE MODERN HOSPITAL
We know too little about other countries — and par-
ticularly, about South and Central America. We
have much to learn and not a little to teach. Are
we ready to set about both tasks now that peace
is here ?
This question is addressed particularly to hos-
pital people. As remarked in the preceding edi-
torial, the hospitals of Chile (and probably the
same thing applies to most of the other South
American countries) are ready and eager for the
best in ideas and products that Europe and North
America have to offer. It is for us to realize that
they have much to offer us in return. A civiliza-
tion longer established on American soil than our
own, of independent development, and heir to a
civilization that is still older, must have much of
interest and value for us. If our attitude toward
our Latin American neighbors has ever been one
of provincial condescension, we cannot too quickly
realize its inappropriateness. The various Ameri-
can countries, already connected by many bonds
of common interest, have certain joint health
problems to work out together — for instance, the
problem of international quarantine, discussed in
this journal some years ago.' Without doubt, the
experience of South and Central America will be
of great value.
Hospital people in the United States have al-
ready developed cordial cooperative relations with
Canada. Canadian hospital men and women are
active and interested members of the American
Hospital Association. Is it not time that the
association signalized its interest in the rest of
the Americas by holding a Pan-American meeting,
which representative hospital and public health
officers from South and Central America and
Mexico should be invited to attend, for the pur-
pose of explaining the desires and points of view
of their respective countries ? And should it not
be the privilege and the duty of our most progres-
sive hospitals to throw open their doors to Latin
American physicians and nurses who desire to
learn what we can teach of hospital administra-
tion and training school methods? Should we
not collect more first-hand information with re-
gard to medical, hospital, and nursing conditions
in the countries to the south of us?
These are but a few of the angles from which
this subject opens up vast possibilities. Are we to
make the most of this great opportunity to knit
our continent together? Or are we to let it slip
by and see the rest of America looking, as of old,
to Europe for inspiration and leadership? We
can not too soon begin to consider this matter
seriously.
1 Plea for a Constructive Pan-American
Hospital, August, 1914, III, 106.
Quarantine, The Modern
Hospital Service in Rural Communities
A most interesting and suggestive "Preliminary
Report on Hospital Service in Rural Communi-
ties" has been prepared by the department of
surveys and exhibits of the International Health
Board of the Rockefeller Foundation. It is based
on the 1890 morbidity statistics of the United
States Bureau of the Census, on figures collected
by the Metropolitan Life Insurance Company in
surveys covering over thirteen thousand cases of
sickness among a total population of over six
hundred thousand, and on data collected by the
State Charities Aid Association in 1913, through
intensive surveys in Dutchess County, New York,
covering an aggregate population of nearly twelve
thousand and total cases of sickness numbering
sixteen hundred.
The study indicates that the general sickness
rate of the country, both rural and urban, is
about 20.8 per thousand population, but that the
rural rate somewhat exceeds the urban. No at-
tempt is made to estimate in terms of money the
economic loss occasioned by sickness among the
employed population, but it is computed that, in
the state of North Carolina alone, over six million
working days are lost by the male population and
considerably over seven million by the female
population. The average duration of sickness
among the general population, including wage-
earners, is found to be from six to twelve days a
year, and from one-eighth to one-twelfth of a
given group of wage-earners are every year dis-
abled for work because of sickness.
The number of physicians available for care of
the sick is much larger in the United States than
in Europe. The population for each physician in
this country is 582, a proportion which is ap-
proached nowhere in Europe. In the European
countries tabulated, the proportion ranges from
one physician for each 1,475 in Scotland, to one
for each 7,865 in the [erstwhile] Russian Empire.
The number of physicians in this country, con-
trary to general opinion, has increased but little
in proportion to the population. There has, how-
ever, been an increase in the demand for medical
service, owing to the broadening of the medical
field and increase of intelligent public interest in
the subject. There are only about half as many
physicians to a given population in the countiy
as in the city, the rural south having the poorest
medical service.
In the field covered by the surveys of the Met-
ropolitan Life Insurance Company 27.2 percent
of the sick received no medical care whatever;
2 percent received dispensary care; 9.8 percent
were cared for in hospitals ; and 61 percent were
cared for at home. Approximately the same pro-
THE MODERN HOSPITAL
465
portion is presented by the figures of the State
Charities Aid Association. Another unfortunate
fact developed by the survey of the latter organi-
zation is that 40 percent of the sick did not re-
ceive adequate care. Nearly half of those cared
for at home, and 20 per cent of those cared for in
hospitals had inadequate care, the insufficiency of
hospital care being due chiefly to lack of social
service and follow-up work.
Possibly the most important divisions of the
study are those devoted to "Some Things That
Need to be Known to Solve the Hospital Pi-ob-
lem," and "How Some of the Information Needed
to Solve the Community Hospital Problem May
be Secured." "A hospital is not a thing of a day.
It is intended to endure through many years and
even generations." In working out an adequate
hospital program, therefore, it is necessary that
many things bearing on local conditions and the
future general trend of sickness be known —
death rate, wealth of population, increase or de-
crease in population of area to be served, social
conditions, percentage of foreign group, character
of industries and industrial diseases, prevailing
type of general diseases, etc. Means by which fun-
damental data on these subjects may be collected
are suggested, including study of the experience
of existing community hospitals, experiment in
the construction of typical community hospitals
through which a close study of community health
conditions might be made, and community sur-
veys carried on through rural home visiting
nurses, who possess peculiar facilities for gather-
ing information, particularly on the point of the
proportion of cases that can be cared for at home
and in the hospital.
We wish that these excellent suggestions might
be put into effect. The way to construct a hos-
pital program is from the ground up, not from the
steeple down — in other words, by a careful and
intensive study of community conditions as a pre-
liminary to any plans for hospital construction
or organization. The principle advanced in this
report that the hospital problem is merely one
branch of the general problem of organizing the
community for the conservation of health and the
cure of disease, moreover, is surely a sound one.
One of the most important pieces of work that
we can imagine would be a survey of health needs
and resources of the country sufficiently compre-
hensive to serve as a basis for a working program
including the organization of health associations,
visiting nursing services, dispensaries, group
diagnostic centers, and hospitals. We hope
that the "Survey of Hospital Service in Rural
Communities" is but the preface to a wider and
more thorough survey of the general problem.
The Death of F. S. Bunn
The American hospital profession has sustained
a severe loss in the death, on November 3, of F. S.
Bunn, of Youngstown, Ohio. For the past ten
years Mr. Bunn had been superintendent of the
Youngstown City Hospital, which, under his man-
agement and largely owing to his untiring devo-
tion and exceptional executive ability, attained a
high standing among the hospitals of the country.
As a personal friend has said, "He was a man who
did his very best and knew well how to make
successes out of the commonplace things." The
manner of his death, as well as his life, attested
to his unpretentious heroism. He died of an at-
tack of influenza, culminating in pneumonia ; and
the fatal issue is ascribed by Mr. Bunn's asso-
F. S. BUNN.
ciates to overfatigue due to his efforts in combat-
ing the epidemic, as well as to the fact that he
insisted that the limited supply of anti-influenza
serum available at the hospital be used to inocu-
late all the nurses before he would consent to
receive a dose himself.
Names of Hospitals Employing the Eiglit-Hour Day
Desired
The Modern Hospital would like to have the names of
all institutions in which the eight-hour day has been in-
troduced. Any remarks as to the results of the change
will also be of interest. The courtesy of those sending in
information will be greatly appreciated.
Four things come not back: the spoken word; the sped
arrow; time past; the neglected opportunity. — Omar Ibn
Al Halif.
466
THE MODERN HOSPITAL
HEALTH INSURANCE AND ITS RELATION
TO HOSPITALS*
Favorable Conclusions with Regard to Health Insurance-
Opportunity for Hospitals to Become Hub of
System — Advantages to Be Received
By THOMAS HOWELL, M.D.. Superintendent New York Hospital,
New York City
In presenting this report to the American Hospital As-
sociation, your committee on social insurance believes that
it will render greatest service if it confines its discussion
to the place of hospitals in a system of health insurance.
Sociologic aspects of the plan are only of general in-
terest to a hospital association and, except as they in-
directly concern us, may very properly be entrusted to the
official state commissions which are making exhaustive in-
vestigations of health insurance in relation to public
policy.
Simultaneously with the work of the health insurance
commissions, some of the best medical talent of the
country has been devoting careful thought to the problem
and, from various angles, has reached conclusions favor-
able to health insurance. It is notable that the reasons
given by several of the prominent leaders in American
medicine for favoring health insurance relate to the de-
velopment of the much needed spirit of cooperation and
coordination in medical service. Dr. Alexander Lambert,
president-elect of the American Medical Association,
favors health insurance because it "offers the very scheme
through which medicine is developing and through which
it is bound to develop to the highest degree in the near
future — that of group medicine."
Dr. Andrew R. Warner, superintendent of Lakeside
Hospital, Cleveland, Ohio, also believes that individualistic
practice of medicine must go, and prophesies that "health
insurance will do much to bring the day when we must
have something better."
Dr. B. S. Warren of the United States Public Health
Service makes the further suggestion that "under health
insurance the medical profession, in its efforts toward
preventive medicine, will also receive outside aid," and
cites foreign experience to show that health insurance
will bring cooperation from "the public, the employers,
and the employees, and will give to each a continuous
stimulus for the prevention of sickness among the wage-
earning population."
Others welcome health insurance because it will bridge
the gap between the medical profession and many data
now inaccessible. Dr. S. S. Goldwater, director of Mount
Sinai Hospital, New York, one of the most earnest
students of health insurance, says he favors "compulsory
health insurance, because industrial conditions which are
inimical to health can be most readily disclosed and most
effectively dealt with under a scheme of health adminis-
tration in which the insured workers are grouped mainly
according to occupation."
Dr. Richard Cabot looks to health insurance for "an
improvement in the treatment of wage-earners by private
physicians because their diagnosis will be checked up by
some one and because any check is better than none."
Perhaps none of these endorsements of health insurance
will carry so much weight with medical men as the report
of the British Medical Association, coming from a demo-
cratic country where health insurance has been actually
tried out. The British Association sent a questionnaire
• This paper wa.s prepared as a report of the committee on health
insurance of the American Hospital Association, to be read at the
Twentieth Annual Convention, but, owing to Dr. Howell's inability
to attend, it was read by title only.
to its members asking for criticism of the act and sug-
gestions. They summarize their returns as follows:
"The degree of unanimity so far disclosed is somewhat
remarkable. On a subject which five years ago was the
most highly controversial that had ever been before the
profession and which still, in some places, and everywhere
in some of its aspects, excites argument, it is found (1)
that many matters which at the beginning of the contro-
versy gave rise to most apprehension have assumed a
position of quite minor importance; (2) that the general
system by which the state provides medical advice and
treatment under the insurance scheme is in the main ap-
proved, and that criticisms have a tendency to concentrate
on a comparatively few points which, though of great im-
portance and indeed vital to smooth working, are, after
all, matters of detail which ought to be capable of adjust-
ment; (3) that there is a large body of opinion in favor
of the extension of the health insurance system, both to
kinds of treatment not at present provided for and to
classes of persons at present excluded therefrom."
Without question, the war has given great impetus to
health measures. Conservation of human life is no longer
a luxury. It is an essential. The medical profession has
risen to the emergency and has made significant contribu-
tions to the science of army sanitation and surgery. Re-
ports from the War Department show that the physical
fitness of the military forces is being maintained at a
most gratifying standard and that there have been im-
portant achievements in the surgical and hospital care of
men disabled in battle.
Conservation of civilian life is a close second in im-
portance. What is being done for the military army
should stimulate national interest in the adoption of
health insurance laws to protect the industrial army
upon which we must depend for munitions, ships and
supplies. As the official commission on health insurance
in New Jersey said in its unanimous report to Governor
Edge, who approved its findings:
"We are told that the work of at least five persons in
the industries is needed to sustain one man in the trenches.
Many thousands, unaccustomed to peculiar occupational
dangers, are entering industry for the first time. Women,
with their greater susceptibility to sickness and with ma-
ternity functions to be considered, are now called into in-
dustry in rapidly increasing numbers. Increased use of
unfamiliar trade poisons and the rapid expansion of in-
dustries are augmenting health hazards. The stress of
industry in war is making increasing demands upon physi-
cal endurance. ... As never before, we need
now to conserve, for present and future generations, the
health and physical vigor of our people. Furthermore, it
is the duty of statesmanship to look beyond our immedi-
ately pressing needs to the period of reconstruction at the
close of the war. We cannot afford to disregard the pro-
tective legislative inducements already offered to work-
men by our keenest commercial competitors in Europe."
The Pennsylvania health insurance commission, also, in
its preliminary report recently made public, makes the
statement:
"In the present crisis, if ever, maximum output is im-
perative, and maximum output depends very largely on
the efficiency of the individual worker. . . . If we are
to equip and supply our army and feed our Allies and
ourselves, and if we are to be ready for the great era of
reconstruction which will follow the war, 100 percent
efficiency for these workers at home must be our goal."
Health insurance as usually proposed includes cash
benefits to make good the wage loss, and medical and hos-
pital benefits to restore health. Compensation for wage
loss is indispensable but, as Mr. Lapp, the director of
investigations for the Ohio Commission, has ably pointed
out, "the restoration of the physical man to working
power must be the primary object" of health insurance.
In restoration it can scarcely be questioned that hospital
service will play a large part. Indeed, it is scarcely ex-
aggeration to say that, if the hospitals are alive to their
THE MODERN HOSPITAL
467
opportunity, they should develop into the hub of the health
insurance system. Considering the inspiring possibilities,
it is nothing short of amazing that compai-atively little at-
tention has heretofore been paid to the place of the hos-
pital in the health insurance plan.
Perhaps we are at fault. Some years ago Dr. Gold-
water gave warning of what was to come, but we did not
bestir ourselves. At that time he said:
"Workmen's compensation is just the beginning of the
great movement that will result in the establishment here
of sickness insurance of the kind already in existence
abroad. ... If there is ever to be a sickness insur-
ance scheme . . . the beneficiaries of that scheme
should be placed in a position where they will get the
service required as part of the workings of the system
itself, which means that the voluntary hospitals and dis-
pensaries . . . must be incorporated into or affiliated
with the system and not needlessly and expensively dupli-
cated by the state."
Health insurance offers positive advantages to hospitals
in increased revenues, wider fields for research, and im-
mediate contact with all who need hospital care.
At the New York Hospital, which is located in an in-
dustrial district, we recognized early that proper handling
of workmen's compensation cases would mean a substan-
tial increase in our receipts. Our annual receipts from
this source at the Fifteenth-Sixteenth Street Hospital, ex-
clusive of fees turned over to our attending surgeons,
were $1.5,065 in 191.5 and $16,474 in 1917. Health in-
surance will have an even moi-e marked effect on receipts.
A large pei'centage of both hospital and dispensary free
patients will automatically become pay patients. Of over
two million days of treatment given by forty-six hospitals
associated with the United Hospital Fund during the
year 1913-1914, 60 percent were wholly free. Of 166,000
patients treated by hospitals reporting to the Pennsyl-
vania State Board of Charities, 159,000 were either free
or partly free, and over 800,000 dispensary patients paid
in little more than $60,000. At the New York Hospital
is was found that 79 percent of wai'd patients and 95
percent of dispensary patients would come under health
insurance as pay patients. The probabilities are that
these percentages are somewhat higher than would ob-
tain in hospitals situated in non-industrial districts. They
serve to suggest, however, the large possibilities for in-
creased revenue under health insurance and tempt one
to speculate in glowing terms of paid staffs and supple-
mentary equipment!
The preliminary report of the Pennsylvania Health In-
surance Commission states that "sixteen of the sixty-
seven counties in Pennsylvania, some of them at consid-
erable distances from better-supplied areas, have no hos-
pital beds whatever and nine other counties have less than
one per thousand population. For the entire state on the
basis of the estimated population for 1918, they found the
number of beds per 1,000 population to be only 2.9 —
scarcely more than half the generally accepted standard.
In Califoi-nia in 1917, where the official health insurance
commission reported a need for 10,000 beds for wage-
earners, 8,621 of the 11,066 beds were in private hos-
pitals, most of which were beyond the means of wage-
earners. Of the remaining 2,445 beds, a large number
were in institutions rated "unsatisfactory" by the State
Board of Charities.
In the Dutchess County, New York, survey of sickness,
it was found that hospital treatment was secured by only
10 percent of the total 1,600 patients, whereas investiga-
tion showed that 28 percent of the cases could have been
adequately cared for only in a hospital. In other words,
nearly two-thirds of those who needed hospital care did
not receive it.
It is worth noting here that the objection raised to
health insurance by the secretary of the Associated
Merchants and Manufacturers of New York State related
to the cost. Necessary care under health insurance, he
declared, perhaps without very careful computation, would
require the expenditure of $100,000,000 more for hospitals
alone to equip New York for this service. Members of
our association scarcely need to be reminded that, despite
an inadequate supply of hospital facilities to meet the
needs of our population, under present conditions we have
more hospitals than we can adequately support. The in-
terests of the community are served better by a small
number of well-supported hospitals than by a large num-
ber of impoverished ones. Until funds are available, hos-
pital facilities should not be extended.
It is here that we may hope from health insurance a
double-barrelled benefaction. Not only will the majority
of our free patients become pay patients, and the majority
of those at present unable to secure any hospital care
whatsoever be enabled to become patients on a paying
basis, but the hospitals will thereby be given funds with
which to undertake long desired improvement and ex-
pansion.
This is all predicated on the assumption that we in-
clude hospital care in our health insurance plan. One of
the great defects of the English law is that it makes no
provision for hospital care. Accordingly, the hospitals are
worse off than they were under old conditions. It seems
hardly probable that we will repeat such a blunder. In
fact, the development of adequate hospital facilities for
wage-earnei's and their families, now so frequently forced
into destitution by sickness, is one of the most beneficent
featui-es of universal health insurance as now proposed in
many of the states.
Not only will health insurance supply funds with which
to improve and expand hospital service, but it will measur-
ably facilitate medical science. Automatically it will
bring under hospital supervision larger numbers of pa-
tients from whom to deduce scientific observations. It
is to be presumed that, within the scope of health insur-
ance, all who need hospital care will demand it and that
the prestige of the health insurance funds may be counted
on to overcome certain prejudices against hospitals.
Health insurance will also have the welcome effect of
bringing patients under hospital care with less of the
delay which is now often fatal. It has been asserted that
the average woi-kman has not a single week's wages
saved for the proverbial rainy day. Losing more than a
few days' time is a serious matter for him. Accordingly,
he does not surrender to sickness until he is actually com-
pelled to do so. When he is furnished protection by means
of health insurance, it is not so probable that he will
hesitate to seek proper attention. Again, it seems safe
to assume that the local funds will encourage early treat-
ment to secure speedy restoration to health. How much
this means will be seen when we consider how early con-
tact with a disease facilitates the work of the physician.
Health insui-ance is not visionary. In the words of
Col. Winford Smith, health insurance "will surely be with
us before many years." It is for us to insist that the
important function of the hospital be recognized. We
must participate with employers and employees in the
shaping of health insurance laws and in their administra-
tion after passage. Failure to do this in the ease of work-
men's compensation led to some unsatisfactory experi-
ences which need not be repeated under health insurance
if we do our duty. It is to our interest, in the best sense
of the word, to lend our professional aid to the proper
468
THE MODERN HOSPITAL
working out of legislation that will meet the need of
health conservation and sickness prevention in industrial
communities. The health insurance system must be so
organized as to offer to the hospital the fullest possible
opportunity for useful development and expansion.
Routine work should be left to general practitioners. Diffi-
cult or obscure cases should be sent to the hospitals. The
hospitals, largely relieved of routine cases, will then be
able to develop group medicine of a high order.
THE MEMOIRS OF A HEAD NURSE
VI. The Color Line — How a Southern Gentleman and a
Camp Meeting Song Pacified Two Bad Niggers
Once in a while, up in the emergency department, we
had a case brought in that was pretty hard to handle —
for instance, the woman of the streets who had taken
bichloride and fought like a tiger when we tried to pump
out her stomach, and the Slav woman who wouldn't let
us set her little boy's broken leg. But, as Mr. Kipling
says, "that's another story."
One day the ambulance elevator came up with what
sounded like a decided row going: on on board. Two
policemen brought out what they would call down south,
a black man and a "yaller gal," the colored folks down
there being known as "black niggers," "yaller niggers,"
and "white niggers," according to their tones and shades
of complexion. Although these shades might vary in
degree from the color of teakwood or mahogany to hand-
polished walnut, birdseye maple or white enamel, they
would still be niggers. The man was bleeding from sev-
eral head and facial wounds; in fact, a portion of his
scalp was scraping acquaintance with his nose, and his
left eyelid was decidedly off the track it usually occupied.
The girl was endeavoring to wrap up a badly slashed arm
and hand in her petticoat, and both of them were putting
up a pretty stiff fight. The air was blue with choice
gutter talk; but, mumbled slowly in the soft southern
negro dialect, it somehow seemed to lose its coarseness
and sounded like the back talk of the end man at a min-
strel show.
After considerable struggling, the pair were taken into
the dressing room. The man was put on the table and
the girl seated in a chair by the window. I tried to take the
history required by the hospital and began with the girl.
"What's your name, and where do you live?"
"It doan' make no difference where ah live, case ah aint
neber dar 'cept when ahm home, and ah aint neber home,
an mah name's mah own bisness, an ah aint goin' ter
hab no doctors puttin' no crazy patchwork stitches in
mah hide, ner no starched nurses askin' foolish questions,
an' you all better look out fo' dat boy, he's a bad nigger.
He's got de razor in his boot what he used fo' to carve
me. It ain't got de bleed wiped off yet. An', lady, I'se
a bad nigger, too."
This didn't look very promising. One of the interns,
who had been trying, with the help of the two policemen,
to examine the man's wounds, heard the gild say "razor
in his boot," and made a "bee-line" for the door.
"Good night," he said, "I'm not going to risk any razor
cuts in my anatomy, thank you. You officers had better
take these people to the jug, where they belong."
It seemed too bad to let them go without something be-
ing done for them, so I said, "Wait a minute, I'll go find
Dr. Beauregarde. You know, he is a southernei-, and
maybe he can handle these people better than we can. We
should at least get some dressings on them before send-
ing them out again." Then I called for Dr. Beauregarde,
one of the senior interns, and he came up, a big, good-
looking chap, with snapping black eyes and a typical
southern drawl. He sauntered in leisurely, as usual,
smoking a cigarette.
"What kin ah do fo' you, little fo'lady of the cuttin'
and tailorin' department?" he asked.
"Please, Dr. Beauregarde," I said, "these colored peo-
ple won't let us examine their razor cuts or even tell us
their names or addresses, and I hate to send them out
again without doing something for them."
He motioned me to follow him with the history slip and,
going over to the girl, said, "Nigger, what's yo' name?"
The girl answered meekly, "Elizer Jackson, boss."
"Oh, yes," I said, "E-1-i-z-a, Eliza."
"No, mam," said the yellow girl, "L-i-z-e-r, Elizer."
"And what's the black boy's name?" Dr. Beauregarde
asked again.
And she answered, "Stoneall Jackson, dey jes calls him
Stone fo' short."
In the meantime Dr. Beauregarde was scrubbing up
preparatory to doing the necessary repair job on Stone,
and the other intern was sewing together the slashes on
Elizer's arm. She was, by this time, getting the second-
ary effects of the cheap whiskey with which she had filled
herself before the fray, as well as of the hypodermic
which one of the nurses had given to her under protest,
and was in a tearful and religious mood.
Each time the sharp, curved surgeon's needle went
through her dark skin she prayed, "Lord have mercy,
Jesus have mercy," and both she and Stone had changed
their gutter accent to a soft "Yeah, Massa," and a "Yeah,
Missus" that sounded as if it was straight from a Mis-
sissippi river plantation rather than from the district of
our big city where even the policemen were afraid to
go alone at night.
Poor "Stone" was really suffering a lot, and Dr. Beau-
regarde, working slowly while he waited for the hypoder-
mic and the local anesthetic to relieve his patient, started
humming an old camp meeting song. Soon, from her
chair, "Elizer'" joined in with the rich contralto obbligato
that comes naturally to the negro women, and, to our
astonishment. Stone, from the head of the table, while
his scalp was being patched together, began crooning a
high nasal falsetto of strangely beautiful sound, almost
like the twang of a ukelele, the whole blending in a primi-
tive harmony that only the southern American negro
knows how to produce.
This is what they were singing:
"Lovin' brother, the worl's on fiah
Doan' yo wan' God's bosom ter be yo pillow?
Doan' yer wan' ter lean on de Rock of Ages?
De Rock of Ages, cleft fo' me — "
The song had as many verses as you had relatives and
continued with variations in the obbligato and falsetto
to include lovin' brother and sister and mother and father
until the relationship was completely exhausted, when it
started on "lovin' brother" again. It was sung in 4-4
time and with a peculiar accent on the first beat of each
measure.
By the time the song was finished and had reached all
around the family and come back to lovin' brother again.
Stone and Elizer were all repaired. We sent them to the
wards for a few days to heal and heard later from Dr.
Beauregarde, who had made them his especial charges,
that he had discovered Elizer's grandmother and great-
grandmother had been born on a Beauregarde plantation
on a Louisiana bayou, and that he had successfully
pleaded with the police court judge to let Stone and Elizer
off, on a promise to be good.
THE MODERN HOSPITAL
469
DETAILS OF HOSPITAL CONSTRUCTION'
Hospital Construction Necessarily Specialized to Meet
Hospital Needs — Some Details of Construc-
tion Which Are Important in Any
Type of Hospital
By N. V. PERRY, Constructing Engineer, United States Public Health
Service
While this paper is primarily intended to treat certain
details of hospital construction developed by years of
experience, study, and experimentation, I also desire to
mention a few things not directly connected with these
details.
War conditions have placed upon the government un-
usual and, of course, unforeseen demands for emergency
hospital accommodations in which the Public Health
Service alone has embarked upon a building program
involving the expenditure of millions of dollars for hos-
pital construction, much of which will necessarily be of
a war emergency nature. For this purpose it has stand-
ardized certain hospital units affording the facilities most
in demand in Public Service hospitals, and, while most
of these buildings are of a temporary natui'e, it is essential
to convenient and economical operation to introduce,
wherever practicable, modern and up-to-date facilities.
Floor plans and details of construction of some of these
buildings are shown in the accompanying illustrations for
your general information and will give an idea of some
of the details of construction to be mentioned later on
in this paper. The buildings in plan show the proper
coordination of facilities required by the Public Health
Service in the care and treatment of its patients, consisting
chiefly of the discharged personnel of the army and navy,
who are beneficiaries of the War Risk Insurance Bureau
under the Treasury Department, the sick of the merchant
marine, and the injured civil employees of the government
entitled to treatment under the provisions of the Em-
ployees Compensation Act.
Public Service hospitals differ in many respects from
general hospitals where male and female patients
are received, and from the older types of marine hos-
pitals, due partly to the introduction of female nurses
and to the treatment of diseases which, as an outgrowth
of war conditions, demand extensive attention. They
should not, therefore, be critically compared with the
modern general hospital. They do, however, present some
very good features which perhaps might be incorporated
in a more permanent type of hospital, and if their ex-
hibition throws new light, either on combinations of ac-
commodations or details of construction, their presence
here will be amply justified.
The Public Health Service constantly receives letters
from various sections of the country, asking for infor-
mation relative to proper design and management of hos-
pitals adapted to almost every phase of hospital woi-k
for state, municipal, and private ownership, and is making
an earnest effort to supply helpful information along
these lines, the direction and scope of which are shown
by Fig. 1.
The Surgeon General has now undertaken the estab-
lishment of a Division of Hospital Information for the
collection, classification, and dissemination of informa-
tion relating to hospital construction, equipment, manage-
ment, etc., which shall have for its chief end the standard-
ization of hospitals and shall make possible a more uni-
form system of management. The need of such a division
has long been felt, and it is believed the Surgeon Gen-
*Rcad before the Twentieth Annual Convention of the American
Hospital Association, Atlantic City, N. J.. Sept. 24-2S, 1918.
oral's efi'oi-ts in this direction will command the hearty
cooperation of the American Hospital Association and
the medical profession generally.
In securing such information, the Surgeon General will,
of necessity, be obliged to depend on the very hearty
and painstaking cooperation of various hospital and
medical associations throughout the country, for in order
to do this most wisely and effectively, it is important
to supplement its knowledge of government hospitals with
accurate information as to facilities and accommodations
supplied in civil and other hospitals, for whatever purpose
required. It must study the construction, equipment, and
management of hospitals both large and small, par-
ticularly those located in sections of the country where
climatic and local environment create conditions peculiar
to themselves, all of which must be thoroughly analyzed
if helpful data are to be secured and intelligent conclus-
ions arrived at.
The Federal government has many millions of dollars
invested in hospitals for the use of the Public Health
Service alone, which are in many respects peculiar to
themselves in that they have been designed almost ex-
clusively for the reception of soldiers and seamen. At
the time of their construction they were thought to be,
and no doubt were, as well adapted for their purpose as
could be devised; but the very rapid progress in medicine
and surgery has rendered many of the requirements of
even five years ago obsolete, and has made necessary ex-
pensive alterations, modifications, or additions to these
plants in order to keep them even reasonably in line
with modern hospital practice.
While there is no doubt that the future will see many
more innovations, it is believed that from carefully com-
piled records of hospital practice and facilities, gathered
from a broad field, it will be possible to say definitely
what will best meet almost any given set of conditions
in hospital design or arrangement, and so to coordinate
each function and facility into a complete plant which
will be so well-adapted for the purpose for which it is
created that the future will see comparatively little need
of expensive remodeling to keep them abreast the pro-
gress of medicine and surgery. It is also presumed the
same will be equally true in regard to their management
and operation, and results that will set new i-ecords in
accomplishment, efficiency, and economy may be looked
for in both of these directions.
Hospital requirements of today are as highly specialized
as is the medical profession itself, some catering to one
branch, some to another — and still others to all branches — •
of the medical profession.
If efficiency and economy is the end sought in building
a hospital for either general or specific treatment of
patients, it is of the utmost importance that the designer
should have an intimate knowledge not only of building
construction, but also of the various activities peculiar to
the particular tMies of treatment involved, as well as the
proper coordination of facilities and accommodations that
will best suit the requirements to which the hospital will
be devoted, for the reason that the arrangement and
grouping of facilities which might be ideal for a general
hospital would not be at all suitable for one specializing
on tuberculosis, psychiatry, etc., as each has peculiarities
requiring facilities and grouping of accommodations
peculiar to itself.
While there are many architects in this country who
special!:^'' on hospital construction and who have broad
experience and opportunities for extended study, yet it
is safe to say that the majority of the hospitals built
today are the product of local architects, who, at best,
470
THE MODERN HOSPITAL
translate into plans the ideas of local physicians and
surgeons, supplemented by such knowledge as may be
gained in visiting one or several nearby plants, vi^ith the
result that there are many hospitals which do not prove
to be economical or particularly adapted to the needs
for which they were created, and which cannot be said to
represent the best practice in hospital design.
While many of the government, state, municipal, and
private hospitals throughout the country are ideally ar-
ranged, comparatively few of them show evidence of a
knowledge or careful study of those details of construc-
^r
^ —
i- —
i_.
TniiJi:
: • 1 y
i.si^zTu Liriia.
-i
LltiJ h
cm
— /
_ _ _ J
convenience, cleanliness, comfort, and efficiency of the
hospital without regard to their relative importance. They
are: ward and operating room lighting, decoration, gen-
eral heating equipment, and floor construction.
WARD LIGHTING
In connection with ward lighting, it must be admitted
that there are many forms of lighting equipment spe-
cially designed for this purpose, some good, some indif-
ferent, and some bad, each of which is found in use.
The general practice in our later type of marine hos-
-^•3teic^^::i^f|->.!_!-,--,-J|
,:;:as
i JC, r,C 57 f D P LAN
GENERAL HOSPl T A L
rOR. A 5M \ L 1. CITY
UNITIVI) ilATtS P'JlllIf HtAl I'll 5EE.VICI1
ivasmin(;ton DC
.SCAI- i: ■ i« IN = > F"T
NP.Hl -SO-
tion which enhance the convenience, operation, and clean-
liness of the facilities affected.
Hospital planning involves the supply of accommoda-
tions for the treatment of various diseases, each having
peculiarities of its own, of which the physician and
surgeon has a definite knowledge. The coordination of
these accommodations and their grouping into a har-
monious whole, however, requires that the architect also
have an intimate knowledge of the activities peculiar
to each set, their proper relation to each other, and a
knowledge of those details of construction best adapted
to serve each unit, in addition to building construction.
if the hospital when completed is to be satisfactory.
While time will not permit lengthy discussion along the
lines of hospital designing, I desire to discuss a few of
the many details of construction which add greatly to the
pitals provides for general ward lighting and indirect
ceiling fixtures, with large and small lamp on separate
switches. The small lamps, to be used at night, furnish
a dim light, but sufficient to see that all is well with-
out disturbing the sleep of patients. The larger are used
for general illumination at other times. Wall lights are
also provided, one over each bed, for local use. These
latter are so placed as to be conveniently operated by
the patients, and so shaded that the rays fall over the
bed area only, but in such a way that the patient whose
bed is lighted cannot look directly at the lamp while
lying in any normal position and is totally out of the
range of vision from adjoining beds (Fig. 2). These
wall fixtures are wired on a separate circuit and are
operated by the patient under regulations prescribed by
the hospital. They also cooperate with the bedside call
THE MODERN HOSPITAL
471
system to indicate the bed from wliich the call originated.
For illuminating operating tables, the Public Health
Sei'vice has adopted the cluster system with specially
constructed reflectors which focus the light rays over
the entire table area (Fig. 3). The lights are wired on
two circuits from entirely separate cabinets in order to
reduce to a minimum the danger incident to a bui'ned-
out fuse. Piping for incandescent gas lights is also in-
stalled, as a further precaution. The illuminating unit
is ventilated to carry off the heat generated by the lights,
which adds materially to the comfort of the room. Wall
outlets are provided for attaching portable, operating-
room-light fixtures or other electrical appliances.
Another important item is the decoration of the various
rooms, and the materials to be used for that purpose.
The scheme of decoration should depend largely on the
illumination both natural and artificial, and the end
sought should be to create cheerful surroundings for
patients, with color effects best adapted to purely pro-
fessional activities, such as operating, x-ray rooms,
laboratories, dark rooms, etc. A standard color scheme
has been devised for all hospitals of the Public Health
Service, and a special mixture of paint specified, both of
which have proven exceptionally satisfactory and efficient.
The most objectionable feature of hospital heating in
general practice is that of heating with return pipes
for radiators passing through the floor so close to wall
as to make it inconvenient, if not impossible, to clean
the floors and baseboard around them thoroughly (Fig. 4).
This has been obviated by the arrangement for the tem-
porary wood frame buildings being constructed as a war
^ ,^ C' ®
There is perhaps no detail of hospital construction
moi-e important than the composition and care of its
floors. Based on careful and extended study of flooring
of various materials, the following conclusions are ar-
rived at: Non-absorbent materials such as marble, ter-
razzo, germanic tile, etc., arc ideal for all baseboards, and
certain floors such as public rooms, halls, operating and
sui'gical dressing rooms, laboratories, x-ray rooms, steri-
lizing and toilet and service rooms (the latter term be-
ing used to indicate kitchens, dining rooms, diet rooms,
etc.). Plastic floors have been widely experimented with
measure, and Fig. 5 shows the arrangement for those
of permanent construction. You will notice that there
are no pipes passing through the floors. Obstructions
for cleaning have thus been avoided, a neater appearance
of the rooms obtained, and, in the permanent buildings,
much floor space saved without in the least affecting the
efficiencv of the heating system.
and have been found satisfactory for baseboards and
certain other purposes, if properly constructed. Pressed
cork tile makes an ideal floor for certain rooms, but
for wards nothing has been found superior to a well-laid
rift hard pine floor, which, when finished in its natural
color and properly smoothed, treated, and waxed, pre-
sents a very attractive appearance, wears well, and is
easy under foot. Cork tile also makes a very satisfactory
floor, but is very expensive in cost and too somber in
color for cheerful effect. Linoleums over wood or other
material make a pleasant floor to walk on, but it is very
diflicult to keep the joints tight together, or the strips
tiaht to the floor over an area of any considerable size,
■though for runways, in halls and in the aisles in the
center of wards, it is very attractive and useful, par-
ticularly when let in flush with the surrounding floors,
as will be noted in Fig. 4.
In closing, let me say that the Public Health Service
has considerable data on these and many other subjects,
which it will be glad to supply upon request. The Surgeon
General will also appreciate contributions in connection
with hospital construction, care, and management, which
when received will be carefully analyzed, filed, and made
available to those desiring such information.
472
THE MODERN HOSPITAL
BULLETIN OF THE
AMERICAN
HOSPITAL ASSOCIATION
M.
Offices:
728 Seventeenth Street, Washington, D. C.
308 Anis6eld Building, Cleveland, Ohio
mthly Bulletin issued from the Executive OB
t 308 Anisfield Building, Cle
[HOWELL WRIGHT, E:
Offlcers
drew R. Warner, President
,eph B. Howland, 1st Vice Presid
B. Tipping, 2nd Vice President
rmena, R.N., 3rd Vice President
well Wrifeht, Executive Secretary
a Bacon, Treasurer
Secretary
Board of Trustees
Dr. Andrew R.Warnei
Vir. Asa Bacon
Mr. Richard P. Borden
Miss Mary L. Keith, R.N.
Dr. Robert J. Wilson
Mr. Howell Wriiht, Secretary
Institutional Membership
To the Trustees and Managers of American and Canadian Hospitals :
The American Hospital Association at its last conven-
tion became a real association of hospitals with the in-
stitutions themselves as the constituent members. Every
hospital and institution for giving medical service should
at once complete its membership. The importance and
need of nation-wide hospital organization was never so
apparent as today.
Our hospitals have become more than a charity or a
means of giving medical and nursing care to the sick;
they have become educational institutions, training men
and women for many fields of usefulness; they have be-
come institutions to promote social welfare; they have
become important factors in the broad movement to
lessen human suffering and loss, the movement often
called "Public Health," which is rapidly gaining impetus
and importance. It is the duty of every institution to
crowd forward to the extreme of usefulness and the front
rank of progress. To this end, universal and general
thought and deliberations upon common problems, com-
mon work and common aims are essential, and isolation
under the wisest of local boards of trustees or managers
is a handicap upon service and progress.
Hospitals are now making their place in the institu-
tional organization of society — with border lines all
around their field of work. There are necessarily many
disputed points and there must be ways of organization,
procedure and relations with other institutions which are
better than other ways. Concerted action is necessary
to determine and fix anything.
It is the plan of the American Hospital Association to
organize hospitals into one homogeneous force which can
be used to promote progress in the work of the institu-
tions and protect the past accomplishments and positions
attained. It is the purpose to form a body which can
speak for hospitals with all the power the institutions can
assemble. The need of such has been demonstrated many
times by legislation which has failed utterly to consider
the viewpoint or the possibilities of hospitals, although
the work of hospitals was a most impoi-tant factor in
carrying out the purpose of the law. The need is also
demonstrated in many other ways.
There is every reason to believe that there will come
to hospitals the same benefits which have come to every
other industry, principle, or purpose which has united all
in a common work or of a common mind into one force,
acting in harmony, with a dignified and definite means of
expression. There is every reason to believe that the
new organization will bring to the individual hospital
workers more benefits than the old.
For the American Hospital Association,
Andrew R. Warner,
President.
Plans for making institutional membership effective in
the association are now being carried out. With the
thought that the hospitals now represented in the asso-
ciation will be among the first to make application for
this new membership, return postal cards have been
mailed to them. The only information desired through
the use of these cards at this time is the name of the
hospital, the name of the president of the board of
trustees and his address for purposes of correspondence.
It is realized that some hospitals — municipal, county and
other types — are not governed Ify a board of trustees.
In such instances, as indicated on the card, the name and
address of the department head or other official to whom
communications about institutional membership should be
addressed is requested. A prompt response to these com-
munications is asked. As fast as replies are received,
a letter addressed to the president of the board of trustees
or other official, signed by the president of the associa-
tion, will be mailed with an application blank to each
hospital. A number of informal applications for institu-
tional membership have already been received. All appli-
cations will be placed by the secretary in the hands of
the membership committee which has just been appointed
by the president as follows: Dr. John M. Peters, Superin-
tendent Rhode Island Hospital, Providence, Rhode Island;
Mr. H. E. Webster, Superintendent Royal Victoria Hos-
pital, Montreal, Canada; Rev. Maurice F. Griffin, St.
Elizabeth's Hospital, Youngstown, Ohio.
Application Blanks
Institutional membership application blanks have been
printed and are being mailed to hospitals. Application for
institutional membership must be made on these blanks
only. The old form of application for personal member-
ship will be continued for the present.
A copy of the institutional membership blank is printed
below. It gives a general idea of the form of applica-
tion and the nature of the preliminary data required for
the consideration of the membership committee. It is
printed only for purposes of information. It cannot be
used as an application blank. A blank form to be used
for this purpose will be found on advertising page 71.
COPY OF
THE AMERICAN HOSPITAL ASSOCIATION INSTITUTIONAL
MEMBERSHIP APPLICATION BLANK
Date
Note — (This application must be signed by the President of the
Board of Trustees or other official representing the governing body of
the hospital. The rest of the blank should be filled in by the Superin-
tendent, who should sign his or her name in the space provided.)
To the Executive Secretary.
American Hospital Association,
308 Anisfield Building.
Cleveland, Ohio.
being an institution duly qualified
( Name of hospital or dispensary )
for institutional membership in the American Hospital Association,
hereby makes application for such membership in the Association and
submits the necessary preliminary date for consideration to the Member-
ship Committee.
Check for $ in payment of the amount required by
the Constitution for initiation fee is enclosed, the same to be returned
if application for membership is rejected.
(Signature of President of Board of Trustees or
other official representing the governing body of
the HospitaL)
( Address for correspondence. )
(See opposite side for initiation fee, membership dues, and other
information relative to Institutional membership contained in the con-
stitution and by-laws.)
PRELIMINARY DATA FOR CONSIDERATION OF THE MEMBERSHIP COMMITTEE
Classification of Hospital
Organization
Governmental (Federal, State, County or Municipal)
Religious ? Church affiliated with ?
THE MODERN HOSPITAL
473
Incorporated for profit? Incorporated not for profit?
Private?
When established When and where incorporated
T>'pe of Hospital Work
( Please indicate whether General Children's
Maternity Tuberculosis Contagious
Other special
Total number of beds in hospital
Ottt-patieyit Work-
Do you conduct a free dispensary? Do you conduct pay
clinics? Do you send physicians from your dispensary
to treat patients in their homes?
REPORT OF WORK DONE LAST FISCAL YEAR
No. of No. of days
Hospital Patients Patients Treatment
Pay patients
Part-pay patients
Free patients
Public charges
(Accepted by county, city or township)
Totals
Pay patients are those for whom at least the cost of their care is paid.
Part-pay patients are those for whom only part of the cost of their
care is paid.
Free patients are those for whose care nothing is paid.
(This classification was adopted by the American Hospital Associa-
tion at its 19th Annual Convention.)
No. of visits to dispensarj- No. of visits to pay clinics
No. of visits made by physicians from your dispensary to patients in
their homes
EDUCATIONAL ACTIVITIES
Medical Education
Does your hospital have univei'sity or medical school connections?. . . .
If so, what connections and with what university of medical school?
No. of interns Duration of service
Do you have resident physicians and surgeons supervising the work
of interns?. No
Niir.e Education
Have you a nurses' training school? No. of years of course
Minimum entrance requirements
No. of pupil nurses No. of graduate nurses employed in
hospital Is your ti-aining school recognized by the
state? Name of Supt. of Nurses
Other educational activities
Training of dietitians
Training of anaesthetists
(Name of Superintendent)
Date received
Date referred to Membership Committee
Action of Membership Committee
Membei-ship Committee
Dr. John M. Peters, Supt. Rhode Island Hospital, Providence, R. I.
Mr. H. E. Webster. Supt. Royal Victoria Hospital, Montreal, Canada.
Rev. Maurice F. Griffin, St. Elizabeth's Hospital, Youngstown, Ohio.
Constitution and By-Laws American Hospital Association
(As Adopteo at the Annual Convention, Sept. 26th. 191S, Ati-antic
City. N. J.)
article I
The name of this Association shall be "The American Hospital
Association."
article n
The object of this Association shall be, to promote the welfare of the
people so far as it may be done by the institution, care and management
of hospitals and dispensaries with efficiency and economy, to aid in
procuring the cooperation of all organizations with aims and objects
similar to those of this Association ; and in general, to do all things
which may best promote hospital efficiency.
article hi
Section 1. The membership of this Association shall be —
A. Institutional.
.4ny corporation or association organized for the promotion of public
health or for the care or treatment of the sick or injured shall be
entitled to membership subject to the following:
Applications for institutional membership shall be addressed to the
Executive Secretary in writing, signed by a duly authorized repre-
sentative of the corporation or asi^ociation; they shall be referred to
the Membership Committee and the applicant shall become a member
upon receiving the approval of the majority of the Membership
Committee and upon the payment of the initiation fees as follows:
Hospitals with a capacity of less than 100 beds shall pay ten dollars;
thoi^e from 100-2.'>0 beds, inclusi
250 beds shall pay thirty dolla]
membership shall pay ten dolla
Constituent Institutional Men
their representatives in the Assc
eligible to active or associate n
the number so appointed no mi
', shall pay twenty dollars; all over
all other organizations eligible to
ers shall be entitled to appoint as
ation any person or persons who are
mbership in the Association, and of
? than three, including the Superin-
tendent, shall have all the privileges and authority of active personi
members and shall be so designated, and others so appointed shall ha%
the privileges of associate personal members.
B.
Active personal members shall be those who at the lime of their
election are trustees or superintendents, or assistant superintendents, of
hospitals, or members of the medical staffs of hospitals, however such
officials may be designated. Any person once an active personal mem-
ber may continue such membership so long as the rules of the Asso-
ciation are conformed with.
Associate pei-sonal members shall, at the time of their election, be
heads of any executive, administrative, or educational department of a
hospital, other than as designated in Section 2, or contributors to, or
members of. any association or board, the object of which is the founda-
tion, maintenance or improvement of hospitals or the promotion of
organized charities for the improvement of health. Associate personal
members may hold oiTice, but shall not have the right to vote at meet-
ings of the Association.
Applications for active or associate personal membership shall be in
writing, addressed to the Executive Secretary, and shall be endorsed
by tne or more members of the Association. They shall be referred to
the Committee on Membership ; and the applicant shall become a mem-
ber upon receiving the approval of a majority of said Committee, and
upon payment of an initiation fee of five dollars for active and two
dollars for associate membership, which shall cover the dues payable
at the next convention of the Association after election.
Section 2. Upon attaining any of the offices designated in Section 2
an associate personal member may become an active personal member
by completing the payment of the dues for active personal members as
provided in the By-Laws.
Section 3. Hon^iarj' personal membership after approval of the
Membership Committee may be suggested at any session of the Asso-
ciation by any member for any person who by reason of public or
private service, or for any other reason, should be entitled to such
recognition ; and such person may be elected an honorary personal mem-
ber by a majority vote of those present at any subsequent session of the
Association.
Honorary personal members shall h.ive all the privileges of active
personal members, except voting at meetings of the Association. They
shall be exempt from the payment of dues.
AJtTici E IV : officers
Section 1. The officers of the Association shall be
Vice-Presidents, an Executive Secretary, a Treasurer
Trustees as herein provided.
The Executive Secretarj- shall serve as Secretary of the Board of
Trustees.
Section 2. The above officei's. other than the Board of Trustees, shall
be elected at each convention, shall assume their duties at the close of
the convention, and shall serve until the close of the convention next
succeeding, or until their successors are regularly elected and installed.
article v: trustees
There shall be a Board of five Trustees, which shall have charge of
the property and financial affairs of the Association, and shall hold
title thereto under the name of "Trustees of the American Hospital
Association." The President and Treasurer shall constitute two of
said Trustees, and one Trustee shall be elected annually, at the conven-
tion, to serve for three yeai*s, excepting that in 1916 ; one of said
Trustees shall be elected for one year, one for two years, and one for
three years. Trustees shall serve until their successors are elected.
The Board of Trustees shall, always subject to the vote of the Asso-
ciation, have general control and management of the business of the
Association, and may appoint and fix the salaries of such officers and
agents as it may deem necessary and expedient and establish rules and
rates for the use of such facilities as it may in its judgment provide.
article VI: sections
In order to facilitate the work of the Association, sections may be
formed and discontinued from time to time, as the Trustees may by
vote determine. Such sections may be geographic, in order that recog-
nized meetings of the Association may be held in various parts in -places
not easily accessible to all membei*s, or may be departmental in their
nature and devoted to any recognized branch of hospital work. Pro-
ceedings of any authorized section of the Association approved by the
Board of Trjstees may become a part of the proceedings of the Asso-
ciation, and any resolution adopted by a geographic section shall be
recognized as a motion duly made and seconded by any general session
of the Association, and vote of the genei*al Association shall be taken
thereon.
>ident, three
a Board of
474
THE MODERN HOSPITAL
ARTICLE VII: ANNUAL DUES
In order to provide funds for the maintenance of the Association,
both institutional and personal members shall pay annual dues as may
be determined by the By-Laws.
ARTICLE VIIi: VACANCIES
Any vacancies occurring between the regular annual meetings in the
office of the President, the various Vice-Presidents, Treasurer, Executive
Secretar>- or Board of Trustees. shaU be filled temporarily by vote of
the Board of Trustees ; any other vacancies shall be filled temporarily by
appointment of the President; and the appointees shall hold office until
their successors are elected by the Association.
ARTICLE IX: AMENDMENTS
The Constitution and By-Laws may be amended by vote of not less
than two-thirds of the members present and voting at a recognized
general session of the Association ; provided, however, that proposed
amendments shall be submitted in writing at a recognized general ses-
sion, and shall not be acted upon at a session at wiiich they are pro-
posed, but may be at any subsequent session.
BY-LAWS
ARTICLE I
Section 1. There shall be an annual meeting or convention of the
Association held at a time and place fixed by vote of the Association, or.
if not so determined, by the Board of Trustees. The President and the
Executive Secretary shall arrange programs for the convention.
Section 2. Special meetings may be called by the President, or in
his absence, by a Vice-President, upon the written petition of not fewer
than ten (10) members. This petition shall recite the object of the
meeting. The President, through the Secretary, shall give notice of
not less than sixty (60) days before the proposed time of such special
meeting to each member of the Association, which notice shall also
recite the object of the meeting.
Section 3. A quorum of the Association shall consist of not fewer
than thirty (30) voting delegates or active members.
Section 4. Meetings of sections shall be held in accordance with the
rules established by the enrolled members of the section hereinafter
provided ; provided, however, that such meetings shall not interfere with
any general session of the Association.
ARTICLE II : ELECTIONS
Section 1. All officers shall be elected by ballot, excepting where it
is otherwise ordered.
Section 2. A majority of the votes cast shall constitute an election.
Section 3. Only the delegates of the constituent institutional members
so authorized by Article III, Section 1, and active personal members
. shall be entitled to vote.
ARTICLE III: DUTIES OF
Section 1. The President shall preside at all meetings of the Asso-
ciation, and of the Board of Trustees, of which he shall be the Chair-
man. He shall appoint all committees, unless, by vote of the Associa-
tion, other provisions shall be made. He shall be, ex officio, a member
of all standing and special committees.
Section 2. The Vice-Presidents shall, in the order of their rank, in
the absence of the President, perform his duties.
Section 3. Subject to instructions from the Association or from the
Board of Trustees, the Executive Secretary shall be the general execu-
tive officer of the Association with duties, responsibilities, and priv-
ileges such as generally accompany such executive positions. He shall
keep the minutes of the meetings and the records of the Association in
books provided for these purposes. Subject to the order of the Trustees,
he may serve as secretary of standing committees, except the Committee
on the Nomination of Officers, and perform such other duties as the
Association and the Board of Trustees shall direct. Under the direc-
tion of the Trustees, the Executive Secretary shall report to the Asso-
ciation the proceedings of the Trustees and also make such report of
his own services as may be advisable.
Section 4. The Treasurer shall receive all dues and other moneys
of the Association and shall deposit and account for same, under the
direction and control of the Board of Trustees. He shall give to said
Board such bond as it shall determine for the faithful performance of
his trust. Such bond shall be in the custody of the President. All
disbursements and expenditures shall be made under the direction of
the Board of Trustees and subject to its rules and requirements. The
Treasurer shall keep proper books of account, and shall present a
report of the finances of the Association at the annual meeting.
ARTICLE IV
Section 1. The President shall, immediately after his election, appoint
a Committee on Local Arrangements to consist of the President and
Executive Secretary ex officio and such additional persons as he may
deem advisable and also the following standing committees of three
members each: namely, A Committee on Constitution and Rule.s, a
Committee on Nomination of Officers, a Legislative Committee, a Mem-
bership Committee, and a Committee on Time and Place of Next Meet-
ing, composed of a tru.stee. the Executive Secretary an<l a member at
large, and the President shall also appoint a standing committee on
Out-Patient Work to consist of three members appointed by the Presi-
dent. The terms of office at the first appointment shall be so adjusted
that one member shall go out of office annually. This Committee shall
undertake such study or activity as may advance progress of out-
patient service and shall report to the Association.
Section 2. The Committee on Nomination shall nominate to the con-
vention the names of the candidates for President, three Vice-Presidents,
Executive Secretary, Treasurer, and one or more Trustee? as vacancies
exist. The action of this Committee is at all times subject to the
approval of the convention.
Section 3. The members of the Membership Committee shall consider
all applications for membership, determine the eligibility of the appli-
cant and express their approval or disapproval thereof to the Executive
Secretary.
Section 4. The Committee on Constitution and Rules shall consider
and report on all proposed amendments in the Constitution and By-Laws
and all Rules of Order.
Section 5. The President shall have the power to appoint such special
Committees as may be deemed desii-able.
Section 6. The Legislative Committee shall so far as possible inform
itself concerning all legislative procedure affecting the Association or
the interests which it represents. Subject to the approval of the
Association or Board of Trustees, it shall actively support all desirable
legislation and actively oppose all unwise legislation.
ARTICLE V: DUES
Section 1. Constituent institutional members shall pay annual dues
as follows: Hospitals of less than 100 beds shall pay annually SIO,
hospitals of 100-250 beds shall pay annually $25, hospitals of more
than 250 beds shall pay annually $50. All other institutional members
shall pay annually the sum of $10. States, counties, and municipali-
ties shall pay in accordance with the above schedule for each institu-
tion accepted to membership. The maximum amount in such case
shall, however, not exceed $100.
Section 2. Dues of active personal members shall be $5 and of asso-
ciate personal members $2 for each calendar year. Life personal mem-
bers are exempt from the payment of annual dues. Dues shall be
payable on or before the first day of March of each year at the office
of the Executive Secretary, provided, however, that the dues of mem-
bers acting as the delegates of institutional members shall, upon request
of such personal members to the Treasurer, be remitted for the period
of delegation.
Section 3. If said dues are not paid on or before the closing of the
annual convention for the current year, the Executive Secretary shall
notify the members in arrears, enclosing a copy of this section ; and
if said dues are not paid on or before the succeeding first day of
January, the delinquent member shall be suspended and thereafter shall
not be entitled to receive notices, or copies of transactions, or to par-
ticipate in the meetings until aU arrears are paid in full.
Section 4. At any time within three years after the date when dues
are first required to be paid, a member who has been suspended shall
be reinstated upon the payment of the amount of dues at the time of
suspension. Otherwise membership in the Association shall be termin-
ated.
ARTlCi-E VI : PUBLICATION OF PROCEEDINGS
Section 1. The Executive Secretary shall furnish the minutes and
proceedings of the regular meetings for publication as soon thereafter
as pi'acticable.
Section 2. The Executive Secretary shall furnish to each member,
except as provided in Article V, Section 2, a copy of this publication.
Section 3. The Treasurer shall upon the certification of the Execu-
tive Secretary pay all bills for printing and publication of the proceed-
ings of the regular conventions.
Section 4. No paper shall be published in the minutes or in any
magazine or paper as a part of the transactions of this Association
except with the approval of the Trustees. All papers read at any
session of the Association or its section shall become the property of
the Association, and when so requested the Board of Trustees may cause
the same to be copyrighted in the name of the Trustees ; but unless
prohibited by the Trustees the authors of all papers read at sessions of
the Association or its sections may cause the same to be published, and,
if approved by the Trustees they may be published as a part of the
transactions of the Association. No paper or magazine shall be entitled
to the exclusive publication of any paper read before the Association or
its sections except by vote of the Trustees.
ARTICLE VII : SECTIONS
Whenever a section is established by the Association or Trustees as
provided in the Constitution, the President shall appoint a chairman and
secretary thereof ; and thereupon any delegate or member of the Asso-
ciation may become a member of such section by enrollment therein.
When ten (10) or more delegates or members have so enrolled, the
chairman shall call a meeting of such delegates or members, and they
may thereupon make proper rules and by-laws for the guidance of such
section, subject to the approval of the Trustees: and such rules may
provide for the method of holding meetings, election of officers, and
THE MODERN HOSPITAL
475
other matters necessary or important for the proper conduct of the
section. The chairman and secretary appointed by the President shall
act until their successors are chosen by the members of the section iti
accordance with the by-laws established by such section.
ARTICLE VIII : GUESTS
Delegates and members of the Association may have the privilege of
inviting guests to the meetings, under such rules and regulations as the
Trustees may from time to time provide. Guests thus introduced shall
be permitted to participate in discussions.
ARTICLE IX : DISCIPLINE
Section 1. All charges of violation and infraction of rules or unbe-
coming conduct shall be referred to a special investigating committee
of five appointed by the President.
Section 2. Due notice of the charges shall be given to the alleged
offender, in writing, by the Executive Secx-etary of the Association.
Section 3. The Association shall have the right and authority to rep-
rimand, suspend and expel any delegate or member guilty of violation
of any of the provisions of the constitution or by-laws of the Association,
after a full and fair investigation shall have been made.
Section 4. A four-fifths vote shall be necessary to sustain the action
of such committee.
ARTICLE X : AMENDMENTS
These by-laws may be amended as provided by Article IX of the
constitution.
Adopted Sept. 26th, 1918. at the Annual Convention American Hos-
pital Association. Atlantic City. N. J.
Sickness and Health Insurance
The following resolutions were adopted at the last
session of the convention at Atlantic City but have not
heretofore been published:
Whereas, the subject of social health insurance has assumed a
position of first importance in public discussion and is now recognized
as an inevitable social policy in this country, and
Whereas, the proper solution of the problem, including the forma-
tion of legislative bills and the administrative organization of the plan
are of prime importance to the hospitals and dispensaries, for the reason
that the fundamental basis of such insurance should be the medical
treatment and rehabilitation of disabled wage earners ; therefore be it
Resolved, by the American Hospital Association that the importance
of health insurance investigation be recognized by this body and the
board of trustees be directed to make a study of the subject in its
relation to the hospitals and dispensaries ; that the boai'd of trustees
give such assistance as may be requested in the formulation of plans
and of legislative bills ; that the members of this association
and the state hospital associations be urged to give the subject careful
study and to cooperate wherever possible in effective solution of the
problems unsolved.
This resolution, together with the report of the legisla-
tive committee, published on page 331 of the October
number of The Modern Hospital, are again called to the
attention of the hospitals. A paper on this subject, read
by Mr. John A. Lapp at the convention, published in the
November number of The Modern Hospital, should also
be read, as well as the paper by Dr. Thomas Howell, pub-
lished in this number of the journal. As pointed out in
the legislative committee report, health insurance vnll
revolutionize hospital responsibilities. Hospital repre-
sentatives should, therefore, take part in the framing of
all such legislative proposals.
In accordance with instructions, copies of the above
resolution, as well as of the part of the report of the
legislative committee dealing with this subject, have been
sent to the secretaries of the health insurance commis-
sions in he following states: California, Connecticut,
Illinois, New Jersey, Ohio, Pennsylvania, Wisconsin.
Also, a letter offering the cooperation of this associa-
tion. The Connecticut and Illinois commissions have al-
ready set dates for hearings. Hospital officials in both
of these states have been urged by this association to
attend these hearings and to give the commissions in-
formation.
Twenty-first Annual Convention
Plans for the 1919 convention of the association are
already under way. The secretary has been to Cincinnati
to confer with local hospital people relative to the ap-
pointment of a local committee and the selection of head-
quarters.
September 29 and 30, October 1, 2, and 3 have been
tentatively set as the days for the meeting.
The names of the local committee and the hotel head-
quarters will be announced in the January number of
The Modern Hospital.
Official Minutes of the American Hospital Association*
Twentieth Annual Convention, Atlantic City, Septemher 24 to 27,
1918, Incll'sive
Tuesday Morning. Sept. 24, 1918.
The convention was called to order by the president. Dr. Arthur B.
Ancker, St. Paul, Minn.
The report of the committee on institutional membership was read
by Dr. A. R. Warner, chairman, who presided during the discussion of
the same at the request of the president. After discussion and upon
motion duly seconded, the report with its proposed amendments to the
constitution was made a special order of business for Thursday morn-
ing, Sept. 26, at 9 o'clock.
The report of the secretary, including the membership and publicity
committee reports, was read.
Resolutions of loyalty to the President of the United States were
adopted by a rising vote.
The president appointed members of the time and place committee
and additional members of the auditing committee.
The meeting adjourned until Wednesday, Sept. 25, at 9 a.m.
Wednesday Morning. Sept. 25, 191S.
The meeting was called to order by the president.
Upon motion duly seconded, the president was authorized to appoint
a special committee on resolutions of nine members, and the names of
the members were announced.
A communication from the Assistant Secretary of War to the con-
vention was then read and referred to the special committee on reso-
lutions.
The report of the war sei-\'ice committee was then read by the sec-
retary, Mr. Richard P. Borden.
Resolutions expressing appreciation to the War Departmient for its
cooperation with the association and its comm'ittees were adopted.
A telegram from Samuel McCune Lindsey relative to the Federal
Inheritance Tax Exemption before Congress was read and referred to
the committee on resolutions.
The meeting adjourned until 2 p.m.
2 p.m.
The meeting called to order by the president.
By unanimous vote, resolutions of good will to the Catholic Hospital
Association were adopted.
The meeting adjourned until S p.m.
8 p.m.
The meeting called to order by the President.
Miss Georgia M. Nevins, chairman of the section on nursing, presided
at the request of the president.
Resolutions endorsing the Lewis-Raker bill providing for nurses' rank
were unanimously adopted.
The meeting adjourned until Thursday, Sept. 26, at 9 a.m.
Thursday Morning. Sept. 26, 1918.
Dr. A. R. Warner, vice-president, presiding.
As a special order of the day, the report of the committee on insti-
tutional membership, with its various amendments to the constitution,
was called up. Several minor amendments were adopted and, upon
motion duly seconded, the report of the committee was unanimously
adopted. (The new constitution is printed in this issue of The Modern
Hospital. )
The report of the treasurer was then read and approved.
The meeting adjourned until Friday, Sept. 27, at 9 a.m.
Friday Morning, Sept. 27, 1918.
The meeting called to order by the president.
The report of the legislative committee was then read and referred
to the board of trustees.
The report of the accounting committee was then read by Mr. Cor-
nelius S. Loder and referred to the board of trustees.
Resolutions pertaining to the following matters were then adopted:
Hospital social service work, control of venereal disease, hospital as-
♦Practically the entire proceedings of the Twentieth Annual Conven-
tion, including a story of each day's meetings, as well as the official
papers, reports, addresses, and resolutions adopted, with discussions of
the same, have already been published or will appear in the next two
numbers of THE Modern Hospftal. Copies of reports made, resolutions
adopted, and names of committees appointed are filed with the official
minutes. The following is a record of the official business transacted
at the meeting. It does not include routine business proceedings of the
sections of the Association.
476
THE MODERN HOSPITAL
sistants, graduate medical students, hospital employees, organization
of civilian physicians for military service, Red Cross survey, affiliation
with army training school for nurses, use of existing hospital facili-
tes. nurses in captivity, Federal Inheritance Tax Bill.
The nominating committee then reported, and the following were
elected: president. Dr. A. R. Warner; first vice-president. Dr. Joseph
B. Rowland; second vice-president. Mr. A. B. Tipping; third vice-
president. Sister Irmena, E.N. ; treasurer, Mr. Asa Bacon; executive
secretary, Mr. Howell Wright: trustee for five years. Dr. Robert J.
Wilson.
The meeting adjourned until 8 p.m.
S p.m.
Dr. A. R. Warner, newly elected president, presiding.
The report of the auditing committee was then read by Mr. Cor-
nelius S. Loder and adopted.
The report of the time and place committee was then read and
adopted.
Resolutions pertaining to health insurance were unanimously adopted.
(These resolutions are published in this number of The Modern Hos-
pital as a part of the Bulletin of the association.)
The convention then adjourned sine die.
Howell Wright. Executive Secretary.
The Institute of Reeducation for Crippled Soldiers in
Bologna
Among the Italian reeducational establishments, the in-
stitute for crippled soldiers at Bologna takes a prominent
place. The building, formerly a convent, is a substantial
and modern structure, but considerable changes were
made to adapt it to its new destination. A new, large
pavilion was added, so that the institution now has room
for 165 crippled men. The well-lighted basement of the
main building contains the kitchen, a dining room for the
nurses, the laundry, and a large basin for bathing. The
central portion of the first and second floors is taken up
by the chapel, which was not changed. The first floor
contains, in addition to the rooms for the nurses, a large
recreation hall for the soldiers and a large covered gallery
in the rear of the building. On this floor is also the
school of telegraphy and typewriting. The third floor
contains a large number of small rooms for the soldiers.
Several large dormitories in neighboring buildings have
also been procured to house a portion of the soldiers. In
the annex are located the various workshops, the carpen-
tershop, the shoeshop, the shops for wickerwork, wood-
turning, book-binding, etc.
A pupil newly entered is left to himself for a few days.
He attends the lectures, visits the various shops, and
thus has time to consider the selection of a trade.
The institute is described in a recent number of the
Rivista di ingegneria Sanitaria of Turin.
The Treatment of External Tuberculosis by Heliotherapy
In a recent article Dr. Cazin defends heliotherapy
against the attacks of writers who have not used this
method in a rational and approved manner and therefore
were bound to fail. Untoward accidents, such as conges-
tions, fever, erythemata, etc., result only if the well-estab-
lished rules based on experience are disregarded. If a
healthy man, by a sudden and long-continued exposure to
the sun, may suffer serious injuries, the same is even more
true in the case of a sick person. The beneficent and ef-
ficacious eff'ects of the sunrays are undeniable, for they
not only influence the local lesions, but have a general
tonic effect on the whole system. In Pott's disease, the
combined method of heliotherapy, immobilization, and com-
pression has cured thousands of cases. But heliotherapy
is not a panacea, as its opponents wish to represent it in
their attacks.
Dr. Cazin's article appears in the Paris Gazette des
eatix.
OCCUPATIONAL THERAPY,
VOCATIONAL RE-EDUCATION
AND
INDUSTRIAL REHABILITATION
Conducted by DOUGLAS C. McMURTRlE. Dircclor Red Cross Institute foi
Crippled and Disabled Men and ELIZABETH G. UPHAM, Advisor
in Occupational Therapy, Mihvauhee'Doivner College.
HUMAN FACTORS IN THE RECONSTRUCTION OF
DISABLED SOLDIERS AND SAILORS*
Influence of Community and Reaction of Man Himself
Two Most Important Factors in Rehabilitation Pro-
cess— Education of Family and Public
Necessary — What Cripples Can Do
By DOUGLAS C. McMURTRlE, Director, Red Cross Institute for Crip-
pled and Disabled Men, New York City, President, Federation
of Associations for Cripples, New York City.
The subject of reconstructing the crippled soldier and
the cripple in general has become so well known and has
been so widely represented in literature that I am
going to assume you are fairly familiar with the theory
and practice of the work. What I want here to speak
about is your relation to it and, more broadly, the rela-
tion of the public to it. We may have the best reeduca-
tional system in the world, the best schools, the best
classes, and the best courses, and yet the whole program
of rehabilitation may break down and be a failure unless
the human factors involved are taken into consideration
and dealt with in the wisest manner. The two human
factors to which I refer are, first, the influence of the
community — at large and individually — on the disabled
soldier or sailor, and, second, the reaction of the man to
the program and the spirit with which he enters into it.
The first community influence which is brought to bear
upon the disabled man is that of his family. I can best
illustrate the importance of this and the way in which
it operates by telling you an incident from the French ex-
perience. As you know, in France the mother of the
family occupies a rather unusual position. She is the
"boss," and, although her boy may grow up to be twenty
or thirty or forty-five, mother still holds a position of
rather unusual authority. In some of the French centers
of physiotherapy, as they call them, it was discovered
that about the time a man was completing his hospital
care and was ready to enter upon reeducation, his mother
would come in from the provinces or suburbs, very much
upset. She would claim they had kept her boy too long
and she had come to take him away because she wanted
him where she could lavish her love on him and take care
of him for the rest of his life. Although they would try
to explain that they wished to train her son so as to put
him back on his feet when he went home, it was too late
to make the explanation. Mother made a scene, beat her
umbrella on the table, and usually carried the boy away
with her. She was running exactly counter to his best
* Read before the Twentieth Annual Convention of the American
Hospital Association, Atlantic City, N. J., Sept. 24-28. 1918.
THE MODERN HOSPITAL
477
interests, yet did not know it, and they could not malce
her understand.
Finally, a new system was tried. When the hospital
care had proceeded to a certain stage, the authorities
sent for mother and said, "Your son's medical treatment
is almost completed, and we thought you would like to
know, in case you planned to to take him away. Of
course, you intend to take good care of him, but you know
you will not live forever. The small pension the govern-
ment gives will not meet all his necessities. You remem-
ber the disabled men from the War of 1870, and you know
what they were doing ten years ago — begging on the
street corners. You would not want your son to come to
that. Across the street is a school of reeducation, where
we can give your son a training course in telegraphy,
and he will go back to his home village and be able to get
a job with the government telegraphs. Instead of being
an idle, useless person, he will be a skilled artisan again,
worthy of the respect of the community, and you will be
very, very proud of him." The whole situation has
changed. Mother goes into the hospital ward and says,
"Son, have you heard what they are going to do for you?"
That is the difference between having the family behind
the program of the government and having them opposed
to it. Unless we can put the families of American sol-
diers behind the program of reeducation and rehabilitation,
that program will fail.
One of the first things we can do for families— and I
think it behooves us to do it — is to take a good deal of
the terror out of going to war. For the men who are
going away the chief concern is not getting killed; it is
coming back disabled. They all say that they would much
rather be killed, and their families have the same point
of view. I was coming down the elevator in a big de-
partment store in New York a while ago, the day after
a leading newspaper had printed in its pictorial section a
photograph of the first amputation cases in the Ameri-
can Expeditionary Force. None of them were more seri-
ous than just above the ankle, and those of us who know
what can be accomplished with the modern artificial limbs
do not regard such amputations as real handicaps. One
lady said to the other, "Did you see those horrible pic-
tures in the paper yesterday?" And the answer was,
"Yes, I did. I hope Jack won't come back that way; I
would rather he were killed." If people knew how much,
or rather how little, that kind of disability really means
when a man comes home ready to do his best and when
the government makes the provision it has, how much
worry would be eliminated!
Then let us suppose that the disability has occured— and
it may never happen. In a little town outside of Philadel-
phia a short time ago they found a woman in a dead
faint on the steps of the post office. When they finally
revived her, it was found that she had opened a letter
from her son abroad which told of an amputation of his
arm in the hospital. She was absolutely inconsolable, and
said she knew that it was worse than death and that there
would never be anything worth while for her son. If in
that state of mind she writes to her son, it is in this spirit:
"My son, I am terribly, terribly sorry that you are going
to be laid aside and that you are going to be forever in-
capable of doing useful work." Such a reaction is not
going to help the fellow at all.
We must see that members of the family know the
game, know what we want from the man, and what will
be done for him, so that their influence on him will help
rather than hinder. Training must always be voluntary.
You cannot force a man to take training, because, although
you may, while he is under military discipline, be able to
compel his attendance in a classroom, you cannot compel
his attention and cannot conscript his enthusiasm. Un-
less you have these, there is no education of an adult.
So it must be voluntary. You must bring a man to the
decision to undergo training, and, to secure the best re-
sults, you must also have his family's consent. You must
further have his family's continued backing while he is
under training, and you must have the same kind of
morale as is maintained for the man's benefit when he is
away at the front. Every letter from the family must
not say in effect: "William, I think you have done this
long enough; you had better come home. It is time you
got back to work and did something worth while, instead
of fussing around this training school business that I
haven't much confidence in." They must say: "We are
with you, old fellow; stick right to it and finish it; if
you do it well now, you will have it settled forever."
Of course, in this work, the social service worker is the
one who can accomplish the most. The home service
workers of the Red Cross are in touch with the families
of a large proportion of the men. Of course, there are
other families with whom this service is not in touch,
and we must try to reach them in every possible way.
After the man comes home, there are a few obstacles
for the family to overcome. The period of adjustment
will be a rather difficult one. The man, taken away from
family responsibilities and home ties, is sent to France for
one, two, or thi-ee years, and comes home after having
lived a life of continuous excitement, always out in the
open, always under pressure. He is going to find it a little
hard to come back to five youngsters and food perhaps not
of the best, as well as to some of the other difficulties that
ensue in the domestic routine. The situation with the dis-
abled soldier is going to be doubly difficult, and it will
require all possible tact on the pai-t of a family and the
family's advisers to get through the period.
Again, the family's reaction too often will be: "Well,
you have done your bit; you have been injured. Now it is
up to the government to take care of you. Settle back and
take it easy; believe me, you have earned it." What they
are advising is the most desperate thing for the man that
can be imagined. They are also liable unduly to coddle a
man who is disabled. A man who is disabled physically, in
the eyes of the ordinary citizen, is a helpless creature; in
the eyes of those who have been used to working with crip-
ples, he is not at all helpless, but entirely able to do
everything for himself. We want the family to under-
stand this; we do not want to have him waited on hand
and foot, encouraged to do nothing for himself, and become
practically an imbecile.
One of the most interesting features in the rehabilita-
tion of American blinded soldiers is that in connection with
the training school in Baltimore, where a house has been
established to which the families of the blind men are in-
vited. The object is to train the families reeducationally
■ and to show them what the blind can do, so that, when
they come home, instead of saying, "Don't go upstairs, you
might fall," they will expect the man to go about the
house and garden and do everything for himself. They
will continue the same quiet encouragement that he has
had during his training; in other words, they will carry
forward his reeducation in his home. That is the ideal;
we want to approximate it as closely as we can.
Another necessity is to impart the right spirit and a
sound social philosophy to the people who are dealing at
first haul with the disabled soldier, to the nurses, to the
doctors, to the aides, etc., who come in contact with him
both on the other side and after his return. This is quite
a mechanical problem, because the medical forces that
478
THE MODERN HOSPITAL
went abroad in the eai-ly months of the war are not
familiar wth what is being done on this side and are not
acquainted with the new method of dealing with the dis-
abled. They must be informed, so that their treatment is
sound socially as well as medically.
The employer exerts a community influence on the dis-
abled man. If left to himself, the average employer will
get together with a committee of his fellows and deliber-
ate about as follows: "Well, we have twelve disabled men
who have come back from abroad — heroes; we must cer-
tainly look out for them. Now, Jones, you ought to be
able to take care of six of these men in your factory, and,
Smith, you could certainly put four in your warehouse,
and, Johnson, you can place two in your store;" and, con-
ceiving their patriotic duty in that way, they accept the
assignments. Jones goes to his superintendent and says,
"I have just agreed to employ six disabled soldiers, so plan
to make places for them." The superintendent looks at
him aghast and says, "Where?" "Oh, I don't know, you
fix them up some way." So the superintendent adds six
messengers or six doorkeepers to the plant. The disabled
soldier is paid $20 a week, let us say, for being a door-
keeper, because it is considered patriotic and because the
community wants to take care of the boys that come home.
What happens ? The disabled soldier goes into the job and
takes his $20. He knows he is not earning that money
and soon realizes he is an object of charity. Every day
that man's character is being broken down, and he is being
made a less useful citizen.
Furthermore, jobs of the character described have no
future; the ex-soldier will keep on being a doorkeeper as
long as he lives. Then, patriotism on the part of the em-
ployer does not last. It may last for six months after the
war is over, perhaps for nine months, peradventure for
eighteen, but, at the end of that time, when the next com-
mercial depression ensues, the plant is forced to sift down
its pay-roll. These disabled men will be. the first to go.
They will go in the most desperate economic condition a
man can imagine, with no confidence and no nerve, no ex-
perience, and no training. They will be turned out with
their physical disabilities, and will be in a bad way indeed.
That is taking care of the soldier from the patriotic point
of view alone.
We need moi-e than patriotic willingness; we need in-
telligence as an added ingredient. We must protect dis-
abled men from employment in jobs of that kind.
When we speak of reconstructing a disabled man and
putting him back on his feet again in a position to earn
as much money or more than he ever earned before, the
first reaction is that of incredulity: "It cannot be done."
Let me give several instances that convey some concep-
tion of the way in which it can be done. If you were
given a case of a man with both legs off above the knees,
you would consider him seriously handicapped. Any pen-
sion board in the world would classify him as totally dis-
abled; any workmen's compensation commission would
classify him as totally disabled, and that man would be
theoretically set aside to do nothing for the rest of his life.
He is seriously disabled, but not to such an extent that he
cannot earn $30 a week with ease. Let us take nine
months to train that man as a linotype operator. He can
use his hands and head in full measure and can do as well
at a linotype job as any man with all his faculties intact —
if he has the training. That man, therefore, with two legs
gone, is no longer handicapped economically. In a big
automobile works of which you all know, disabled men
have assembled engines passing along on an endless belt.
The cylinder heads have to be sealed with a certain kind
of compound, and as they pass, a man takes a brush and
runs it around the top of the cylinder. If that man had
two hands, he would have one in his pocket and be working
with the other. He has only one, and does the work with
that.
In a report on work for the blind abroad, I read lately
that a great many blind men were employed in a clock
factory. The modern clock has for a gong a spiral tem-
pered wire which must be tested to determine its tone and
adjusted by a screw on the end to make the tone come
right. They use blind men exclusively for that job, which
is a highly skilled one. Could a sighted man do any better
than a blind man in that position? Certainly a blind man
is under no handicap whatever. In a large factory making
magnetos for high-class automobiles, go to the assembly
bench and you will find a blind man working deftly. Is
a blind man a poorer or a better employee in that job than
a man with sight? The employer considers him a better
one, because he does not look out of the window to watch
a girl walking down the street; he goes at his job and
keeps at it until he finishes, and he never makes a mistake.
The sense of touch is more delicate, it seems, than the
sense of sight. In one electrical works where porcelain
insulators are put on a certain product, a member of the
firm said they had put on about 1 percent of defective
porcelain pieces, which later had to be thrown out by in-
spectors. Since they have employed blind men on that
work, they have never had one piece of defective porcelain
and have dismissed their force of inspectors.
I do not mean that rehabilitation of the disabled is easy,
but I do mean that it is possible, and in the multiplicity
of industrial processes today, you can, by looking far
enough, find jobs for a man with any kind of disability,
which he can fill as well as his able-bodied fellow.
Let us now consider the influence of the public at large.
We pity the disabled man and pity him so obviously that
he comes very soon to pity himself — and a very natural
thing it is. In practically all the French schools for the
blind you can see on the wall — the blind men, of course,
cannot see it themselves^ — "Don't Pity the Blind;" and by
that they mean, don't pity them in their hearing. This
has become necessary because the first reaction of every
visitor was, "Oh, the poor things!" This was desperately
wrong, because the very thing they were trying to do was
to encourage the blind man and tell him he had everything
before him. The universal reaction: "That is a shame —
oh, what a pity!" is anything but helpful.
We must inculcate in the public a belief in the capability
of the cripple and of the man with other types of dis-
ability. We must put across publicly the conception that
the ci'ipple can do things if we will only regard him in the
light of his ability rather than in the light of his disability
— if we will forget the disability he has and seek for him
some jobs in which his ability will become effective.
From one of the New England towns to which have
returned quite a few disabled soldiers it is reported that
no one could tell whether they were suffering from shell-
shock or intoxication. The average man on the street
thinks the best way he can show his regard for the soldier
who comes back from the front is to buy him as many
drinks as he can at the corner saloon. Luckily, that oppor-
tunity viall not exist for long. But it exists now, and it is
indicative of a very pernicious attitude toward the dis-
abled man.
From Montreal, several years ago, came the report of
difficulty caused by the fact that the men who came back
disabled were being spoiled by the community. One man
in particular, whose family had been under the care of the
THE MODERN HOSPITAL
479
Canadian Patriotic Fund, returned from the front. His
vfiie and children had been looking forward anxiously to
his homecoming. But they did not see much of him. A
holiday, however, was coming, and they finally elicited the
promise from father that he would take mother and the
children out to the park that day. The morning came and
mother began to get the youngsters ready, but father
showed no signs of starting. Finally she asked him,
"Aren't you going to take us out to the park to-day?" He
replied, "Oh, no, I have got to go to a sing-song at the Ritz
this morning and for a motor ride this aftei-noon." The
society ladies were helping the returned hero to build up
Tiis character! You will find this attitude so universal
that, in many ways, it is the most dangerous influence
with which we have to deal.
In dealing with the public as a whole, we must urge that
every influence on the disabled man be measured as to
whether it is constructive and helps to build up his char-
acter or whether it is destructive and tends to break it
down. Luckily, we have at our disposal an agency to deal
with the influence on the disabled soldier, in the form of
public education. Public education I consider one of the
most necessary elements in any national program — though
it has been neglected, to their great sorrow, by some of
the foreign governments. They have built up systems of
rehabilitation, but the public has not understood them; and
the public has spoiled them or is spoiling them very fast.
We can reach the man in several ways — in the first place,
by direct statements, cards, booklets, and the like, which
can be distributed in the hospitals, which will tell him
what the program of reeducation is and what the nation
seeks to do for him when he gets better. You can picture
the ordinary reaction of the man who is disabled. He is
not only a well man, but he has been selected from the
physical pick of the country. When he is struck from that
condition into a condition of what he conceives to be total
disability, he is pretty much discouraged, because he
knows that the man who worked next to him in the
machine shop or factory, who was earning $35 a week, is
now selling shoestrings on the main street, and he could
go on and repeat in his mind thirty or forty instances of
that character. He knows that physical disability has
meant dependence, and you have to start at the earliest
possible moment to admit past faults and tell him that
we are learning and have something better in store for
him.
One of the interesting things that has been done is the
preparation by the office of the Surgeon-General of the
Army of a series of educational films entitled "The Way
Out," which gives the history of successful American
cripples and demonstrates that losing an arm or a leg
does not necessarily mean helplessness. They are being
shown or will be shown at all the military hospitals abroad
and in this country. I remember the story of a man in
Kansas City who, the moment he heard of a man run over
in the street, made it a regular practice to go to him at
the hospital and say, "Don't worry, you have only a
leg gone, and I have a leg and an arm gone and it doesn't
worry me a bit."
That is the policy of encouragement of cripples by crip-
ples. The Germans have issued a book entitled "The Will
Prevails," which gives the autobiography of a thousand
successful cripples from the middle ages down, and it
teaches that, if a man makes up his mind to make good,
he is not crippled at all. We have at Baltimore the Red
Cross Institute for the Blind, and the first American sol-
dier who returned blind got along finely, caught the spirit
of the thing easily, and became encouraged and was mak-
ing good progress. The first American sailor who came
there wanted to commit suicide. Nobody could do a thing
with him; he wanted to die and die quickly. They could
not make any progress with him until finally they decided
to let the blind soldier take him in hand. They left the
two together, and in three days they were going about
laughing and the sailor was on his way to success.
Another influence is organizations of cripples them-
selves. In one of the leading French schools of reeduca-
tion there is an alumni association which is called upon to
settle all difficulties that arise. The alumni can give the
trainees the practical benefits of their experiences, and
their ai'guments are more persuasive than good theory.
Now, there remains the part the family can play in the
program of reeducation. We can reach the family through
general publicity, because most of the people we reach
now are families of soldiers, and we can also reach them
through the home service of the Red Cross or similar
organizations, for one of the responsibilities the Red Cross
Home Service has undertaken is the education of the peo-
ple under its care.
The employer can be educated in several ways. The Red
Cross Institute for Crippled and Disabled Men in New
York City has been trying to reach him through the cham-
ber of commerce. Practically every chamber of commerce
has transmitted a message to its members with its en-
dorsements, telling them the wrong and the right way of
intelligently helping. The public at large can be reached
through every possible form of communication, and can
be reached directly. The American Telephone & Tele-
graph Company recently distributed in the United States
for the Red Cross five and a half million folders which
pointed out the duty of the public toward the disabled man.
The newspaper, by stories of what is being done in the
field, makes reeducation appear a logical and practical
thing. The magazines also assist in this, and one of the
essential things being done is to educate the writers of the
country to present to their readers the cripple in his
proper light. In the past, when a cripple was mentioned
in a book or in an article, it was with a sob — and a very
hopeless sob, at that. We want to change all that, because
that sort of thing is not constructive.
Public speaking, of course, is another valuable medium
of publicity. We assume there will be built up a service
of public speaking through the country which will carry
to everybody the general gospel of reeducation. The
theory is not obvious; what we tell the employer is not
obvious, but it is logical and he understands it. Once he
has heard it, he will never slip back to his old conception
of disability.
Now, the other human factor is the spirit of the man
himself. In the past, we have been accustomed to speak
of cripples as beggars, and as "down-and-outers," and I
think for that we have only ourselves to blame. The
cripple usually starts right; he does not want to be de-
pendent. The average man comes from some useful
activity; he is injured and does not want to be an object
of charity. He does not want to beg, but, by his relation-
ship to the public, he is driven into the status and atti-
tude of a pauper. A railway surgeon from the West told
me quite a few years ago that in his experience — and we
did not talk then of scientific care for cripples — "when-
ever a man is run over on a railroad, I know if I can get
hold of him the day he comes out of the hospital, I can
make a success of him, but if I let him go three weeks,
he is gone." This statement all of you can probably verify
fro... yoiT own experience. If you start the man right and
arrange so that he will not be subjected to too much dis-
couragement and adverse influence, he will succeed.
I wonder if you i-ealize just what cripples can do — what
480
THE MODERN HOSPITAL
American cripples can do when they summon their nerve
to it. We have in New York at the Red Cross Institute
a good many civilian cripples whom we are trying to put
on their feet. We find that one of the most helpful things
we can do is to arrange cripple parties or meetings in
which they are brought in contact with other cripples
who are not "down-and-out," but who are making good.
One of these meetings made a deep impression on me.
There were four or five speakers, all of about equal caliber
and success, but I have time to tell you only of two. One
was a man from the Southwest who was run over in a
railroad accident and both his arms were taken off. One
arm was taken off — in fact, it was not an arm amputation,
because part of his collar bone was gone as well — and the
other arm was amputated just below the elbow. That is
a tremendously serious handicap, infinitely more serious
than a double leg amputation, because, with both arms
gone, a cripple is subject to the ignominy of having people
dress him and look out for him generally. This man did
not want to be a beggar and tried to make his own way,
but the road was hard, and discouragement met him at
every turn. He said that in a short length of time he
called on two thousand employers asking them for a job,
but they all looked a little embarrassed, smiled sympa-
thetically, handed him half a dollar, and said that they did
not have any jobs at the moment. It was always the half
dollar and never the job. Almost reduced to begging
food from door to door to keep life in his body, he still
retained his ambition. He knew one man, a friend of his
father's, and to him he said: "I am not going to ask you
for a job, because I know you would laugh at me, but you
have a lot of jobs and I am going to ask you to let nie
take a chance at some of them and see if I can do the
work. Just let me try; don't put me on the pay roll."
The man let him try. He was in the contracting busi-
ness, and among the things he did was laying street pav-
ing. One of the jobs was to check the number of paving
blocks issued to the workmen. The cripple said, "I can
do that as well as a fellow with two arms." He did — with
the result that he was put on the pay roll and started to
advance. He began studying law in the evening and was
admitted to the bar. Meanwhile he had been working on
his own artificial apparatus, and, in comparison with all
the scientific devices developed abroad, we consider that
his apparatus, devised and manufactured by himself, with
both arms off, is as ingenious as any we know. He studied
law, manufactured his apparatus, and did all he could to
help other men with two arms off. He is interested, not
in one arm cases, but in double amputations. He ran for
justice of the peace, was elected, and then ran for county
judge. Quentin D. Corley has now for three times been
elected to that latter office. He prunes his own peach
trees, runs his own automobile, and does everything for
himself, even to taking off his collar and tie. You can
insult him in only one way, and that is by offering to do
something for him.
The other speaker was a man who was out in a bliz-
zard and, as the result of exposure, had his four extremi-
ties frozen. When he recovered, he had to have amputated
both legs, one arm, and four fingei-s off the other hand.
He had no resources whatever. The county supervisors of
the poor took him under their custody and agreed to sup-
port him. Soon he got tired of being kept by the county
and said, "I have to make good; I haven't any limbs; the
only thing about me that is not cut up in some way is my
head; I guess I had better start to polish up the ma-
chinery above my neck." He went to the three supervisors
and said, "I want to make you a sporting proposition; I
am healthy, I will live on you until I am ninety if you
leave me here, but if you will give me one year in college,
I will never cost the county another cent." They delib-
erated until the early hours of the morning before reach-
ing a decision, and, in the words of the disabled man,
"Thank God, there were two sports on the board." He
made good; he carried out his end of the bargain, and
Michael Dowling has since been speaker of the House of
Representatives in the state of Minnesota and is now
president of one of the most prosperous banks in that
state. He married since his accident and has three daugh-
ters, one of them now going through one of our leading
girls' colleges and her sisters prepared to follow her. He
drives his own automobile, and he says that physical
handicaps disappear the moment you make up your mind
to conquer them.
These are the human possibilities. A European writer
says in what is, to me, a very inspiring way, "There are
no more cripples," and the work that is being done in
rehabilitation is certainly demonstrating the truth of that
statement today. Physical handicaps, yes — but social and
economic handicaps, no. Some of the men who are abroad
today are coming home disabled; they are coming home
to a task greater in some ways than the one which they
are doing so well now. I am confident that they will dis-
charge that task and win their second victory so that we
will be as proud of them then as we are now proud of
them in winning their first. And I am confident further
that you — and the Ameincan public — will not put one
straw in the way of their success.
Emergency Course of Training for Reconstruction Aides
In accordance with the call issued by the Surgeon-Gen-
eral for a thousand women to serve in military hospitals
at home and overseas in the teaching of hand crafts and
other subjects to disabled soldiers, the committee of the
National Society for the Promotion of Occupational
Therapy has set up an emergency course to be used in
the training of reconstruction aides. The proposed quali-
fications and requisites for entrance to this course are
three: age, educational, and special. Applicants should
be between twenty-three and forty-five years of age, al-
though exceptions may be made for those especially
qualified. A general high school education or its equivalent
is necessary, and college or normal ti-aining is desirable.
The special requirement is that of technical training.
Knowledge of at least one craft is essential, as well as
the ability to teach the elements of one academic sub-
ject. Experience in social sei'vice, nursing, teaching play-
ground work, physical training, or kindred subjects will
make an excellent basis for development.
The course of training will include lectures and man-
ual work in the crafts. The lectures cover the elements
and history of occupational therapy and applied psy-
chology, especially in relation to the various kinds of phys-
ical and mental handicap, and also include training in
hospital routine and etiquette.
The work in the crafts includes woodworking, chair-
caning and rush seating, basketry, cord work, clay-model-
ing, simple weaving, rug-making, dyeing, bookbinding,
simple metal work, application of design, and practice (
teaching.
I borrow joy from sorrow —
A Rainbow from the Rain!
If life were not in Shadow,
My Star would be in vain —
— R. Valentine Heckscher.
THE MODERN HOSPITAL
481
DISPENSARY
AND
OUT-PATIENT
WORK
Conducted by MICHAEL M. DAVIS. Jr.
Director of the Boston Dispensary.
Please address items of news and inquiries regarding Dispensary
Out-Patient Work to the editor of this department, 25 Bennett street,
Bosto
Mass.
CLINICS FOR VENEREAL DISEASE
I. Equipment for Separate Treatment of Syphilis and
Gonorrhea — Adaptation to Small Hospital or Dis-
pensary— Details and Approximate Cost of
Furnishing Small Clinic
Bv MICHAEL M. DAVIS. JR., Director of the Boston Dispensao-.
In a large out-patient depai'tnient or dispensary, the
clinic in which syphilis is treated may be separate from
that dealing with gonorrhea; in fact, this separation is
desirable whenever practicable. The equipment for the
two diseases will be outlined in the following as for two
separate clinics. A section relating to adaptation to small
or large clinics will be appended.
1. Syphilis
"A syphilis clinic needs as good light as a dermatolog-
ical clinic. There must be a history room, an examining
room for each physician on service, and a special room
for the administration of salvarsan. The staff must have
facilities for Wassermann tests and a dark-field micro-
scope for examination of primary lesions. The main
laboi'atory of the dispensary may provide these facilities.
In many institutions the Wassermann tests will be per-
formed at the laboratory of the municipal or state depart-
ment of health, but the clinic itself must provide for the
diagnosis of early cases. The growing importance of
lumbar puncture in the diagnosis of syphilis of the cen-
tral nervous system renders it essential to have facilities
for this. There is still some difference of opinion as to
how far it is safe to perform lumbar puncture as an out-
patient procedui'e, the patient going from the building
shortly after the operation. Many clinics of standing
have had excellent results and no serious drawbacks from
the performance of lumbar puncture in this way. But
some selections of cases must be made, and it is desirable
to have facilities for keeping patients over night, although
they need not be utilized for every patient." '
2. Gonorrhea
"The equipment for the diagnosis and treatment of
gonorrhea will include accessibility to a laboratory for
examining smears and urine and making complement-
fixation tests. Examining and treatment tables, with
irrigators, sounds, catheters, dilators, bougies, etc., are
necessary. The cystoscope is essential, and a special room
and table for cystoscopy are desirable, though not neces-
sary. Some genito-urinary clinics do a good deal of oper-
ating under local anesthesia and a special room for this,
with operating and instrument tables, etc., will be re-
quired. Such a room may also serve for the cystoscopic
work The sterilizing equipment must be carefully looked
to. Much the most convenient arrangement is to have
the treatment room cut up into a series of small rooms, or
booths, so that each patient has a room or compartment
to himself during treatment. This compartment should
preferably contain a small instrument sterilizer so that
^ This and several following paragraphs, within quotation marks,
are cited from "Dispensaries, Their Organization and Management,
by Dr. A. R. Warner and the writer of this article.
each physician can have his instruments, gloves, etc.,
readily accessible. Much time is saved by such an ar-
rangement, and privacy is gained. A utensil sterilizer
for the basins, etc., is a necessity in the clinic. There
must be a urinal immediately accessible, preferably within
the clinic. A clinic providing for three physicians, treat-
ing rnen only, should have a trained attendant or clerk
and, if possible, a male social worker, an admission or his-
tory room, two treatment rooms or booths with the urinal
accessible, and a cystoscopy room. If women are also
to be treated during the same clinic period, an additional
history room, a treatment room and a nurse will be re-
quired.
"Gonorrhea in females is sometimes treated in the
gjmecological department. The sequelae and complica-
tions of gonorrhea closely involve the surgical aspects of
gynecology. In some institutions, however, gynecology
is combined with general surgery in the dispensary, and
gonorrhea, as such, among both sexes, is received "in the
genito-urinary clinic."
3. Relationship to Other Clinics
I. SYPHILIS
"The great variety of local symptoms arising out of
this disease cause patients with symptoms which are
really the result of syphilis to appear in every depart-
ment of a dispensary. For the sake of clinicaTeffective-
ness in diagnosis and treatment, and for the protection
of the public health, it is essential that every dispensary
lay down the rule that all syphilis be the responsibility of
a single department. Whether this department shall be
a special clinic for syphilis or a genito-urinary depart-
ment treating syphilis and gonorrhea, or whether it shall
be a department of dermatology and syphilis, is a matter
for detailed consideration."
"The department where is placed the responsibility for
the treatment of syphilis must depend on the oculist to
help with an eye condition, the surgeon, perhaps, with a
syphilitic ulcer, the medical clinic with a heart condition,
the children's clinic with a difficult feeding case of con-
genital syphilis. The neurological department must have
jurisdiction over its special manifestations of the disease.
"These general principles should be laid down: (1)
Concentrate the responsibility for syphilis in a single de-
partment; (2) let its local manifestations or symptoms
be examined or treated in those clinics to which they es-
pecially relate; but (3) require the patient to report for
constitutional treatment at periodic intervals, as required
by the condition, to the department having the general
responsibility for syphilis. The department having the
primary responsibility for syphilis will thus carry all
syphilitic patients on its follow-up system, but some of
the same patients will also be carried by other clinics.
This relationship is particularly important in dealing with
cases of neuro-syphilis.
"One means of enforcing these principles in practice
is through the requirement that the Wassermann test
shall be done only through a single department, e. g., the
central laboratory, and that the occurrence of a positive
Wassermann (or any other test which indicates syphilis)
shall automatically cause a patient to be transferred to
the department having the primary responsibility for
syphilis, the patient being placed on the follow-up system
of the syphilis department."
II. GONORRHEA
"If both men and women are treated in the genito-
urinary clinic, the two sections must be kept adminis-
tratively separate to a large degree, with separate wait-
ing-rooms. If syphilis as well as gonorrhea is treated, the
equipment and arrangement specified above must be in-
cluded, and at least one additional room will be required
for men and one for women. Assuming for the moment
that only gonorrhea and the surgical aspects of genito-
urinary diseases are included within the scope of this
clinic, "the following may be outlined:
"Gonorrhea is a disease which requires frequent visits
and a fairly long period of treatment, and therefore the
proportions of visits to new patients will be large. Even
including those cases which are transferred to other in-
stitutionr. which move away from the city, seek treatment
elsewhere, or which are 'lost,' the average visits per
patient among gonorrhea cases should be between fifteen
and twenty, and any lower figure should arouse question
whether proper supervision and control of the disease is
482
THE MODERN HOSPITAL
exercised. This test must not be applied to a genito-
urinary clinic as a -whole, since a certain proportion,
sometimes a large proportion, of the cases in the clinic
are not gonorrhea. The chief of the clinic should see all
new cases. In a large clinic the patient is usually as-
signed at the first or second visit to an assistant for
treatment, if this is of a routine character; but the chief
himself or a designated assistant would ordinarily attend
to a case where the cystoscope was necessary. It is de-
sirable that the chief, "or a specially designated assistant,
should see the patient at each revisit to note progress
and indicate further treatment. The same physician thus
sees the patient each time, even though a different physi-
cian may give the local injection, etc. The presence of a
clerk or "trained attendant to attend to records and details,
care for instruments, the follow-up system, etc., is essen-
tial unless the clinic is a small one."
These principles of organization will be elaborated in
the second article of this series on clinic management.
4. Adaptation to the Small Hospital or Dispensary
Conditions in the small hospital, located in a town of
25,000 or 50,000 persons, differ widely from those in a
great metropolitan institution. Resources are much more
limited, both as to medical personnel and as to equipment.
Furthermore, in the smaller community there may be
more sensitiveness on the part of patients in attending
a clinic for venereal disease, because of the fear of meet-
ing people they know. This difficulty is almost entirely
obviated when the venereal clinics are part of an out-
patient department in which other diseases are received.
Such a policy is desirable in all cases.
The small hospital or the hospital of moderate size
which is starting venereal clinics, may be assisted by the
following detailed list of furnishings and equipment.
The expense of maintenance may be reduced to little or
nothing if some or all of the clinics are made pay clinics.
The initial expense need alarm no institution which has
either funds or courage.
5. Furnishings and Equipment for a Small Clinic
I. ROOMS
1. Waiting room. The sexes need not be separated,
providing the room is a public passage-way, or is under
the eye of a nurse or clerk. If it is a secluded room,
separate partitioned spaces or rooms should be provided
for women and children.
2. .A.n admitting or history room.
3. At least two examining and treatment rooms.
Where more than two doctors are at work, there should
be three such rooms, and it is a convenience to have three
in any case, since the equipment for the different types
of v/ork can be better distributed. All these can be small
rooms; 8 by 10 feet vriW do, or even 7 by 9 feet.
II. FURNITURE
The minimum requirements are (1) two writing tables
or small flat-top desks ($5 to $10 each) ; (2) two examin-
ing tables, which had best be of white enameled iron
($18), although more convenient and expensive adjustable
tables can be purchased; (.3) three small white enamel
instrument stands ($10 each).
In addition to the chairs or benches necessary in the
waiting room, at least eight chairs for doctors and pa-
tients will be required in the clinic. If there are three
doctors or three examining rooms, three examining tables
and an extra instrument table and desk will be necessary.
III. STERILIZING EQUIPMENT
1. Instrument sterilizers; the common "fish-kettle"
($2.50) to be used over gas will do, or an electric self-
closing sterilizer costing from $12 to $20.
2. A dressing sterilizer (autoclave) is necessary, un-
less provided elsewhere in the hospital (cost $150).
3. Utensil sterilizer, costing $85 and up, is essential.
unless provided elsewhere in the hospital. If there are
three doctors working, two instrument sterilizers will be
desirable. Total cost of sterilizing equipment would be
within $260, and might be one-tenth of this if the
hospital had the two larger sterilizers accessible. The
instrument sterilizers must be in the clinic, anyway.
IV. MICROSCOPY, LABORATORY SUPPLIES AND ACCESSORIES
1. Microscope, $85 plus.
2. Dark stage and illuminator, $45.
3. Minor accessories for microscope, and simple equip-
ment and chemicals for routine urine and bacteriological
examinations, $25. An electric centrifuge for the exam-
ination of urine is highly desirable, costing about $50, but
hand centrifuges, costing $10 or $15, can be made to serve.
V. SPECIAL EQUIPMENT FOR SYPHILIS
.Apparatus for the injection of salvarsan and for the
taking of blood for Wassermanns; hemostat, syringes,
needles, basins, and instrument trays, Erlenmeyer flasks,
glass graduates, total cost $15 to $20.
VI. SPECIAL EQUIPMENT FOR GONORRHEA
Instruments including sounds, bougies, catheters, di-
lators, syringes, irrigating stands, rubber gloves, tubing,
finger cots, etc., about $75 for the necessary sets.
A catheterizing cystoscope, with batteries, about $85.
A cystoscopic table, costing about $50, would be a con-
venience, but the ordinary flat examining tables can be
used quite well.
No instruments for surgical work are included.
An instrument cabinet, made to lock, would cost from
$20 to $50.
Stock of linen, cotton, etc. — $25 would give a start.
VII. CLERICAL SUPPLIES
Equipment sufficient to provide for 2000 record cards
would include index drawers for 3 by 5 cards, $5; med-
ical record card drawers for 5 by 8 cards, $9 ; visible file of
one of the two frequently used types, $4 to $12; cards
properly printed for use in the follow-up system with the
visible file, $4 per thousand, if printed in quantity; med-
ical recoi'd cards, printed, $4 per thousand; 3 by 5 cards,
$3 per thousand; rubber stamps, date stamps, receipt and
report forms, $25.
VIII. MEDICINES
If there is a pharmacy in the hospital, these are readily
provided. Otherwise, a special set of medicines will have
to be purchased, compounded, and kept in stock. The
usual medicines used in the treatment of typical, acute
gonorrhea cost (for the materials) fifty cents to a dollar
per week during the early stages (the retail drug-store
prices are two or three times this sum) .
I.X. SUMMARY — (for A CLINIC USING ONE OR TWO DOCTORS)
1. According to local conditions.
2. Furniture: $100 up, not counting benches or chairs
in waiting room.
3. Sterilizing equipment: $260.
4. Microscope and laboratory: $165 to $205 or above.
5. Special syphilis equipment: $20.
6. Special gonorrhea equipment: $230.
7. Clerical supplies: $70.
Total: $845 or above.
A hospital might well have, all ready to provide, part
of the furniture and sterilizers, the microscope, chem-
icals, part of the special equipment for syphilis and gon-
orrhea, and the linen, etc. The cost of the extra equip-
ment might then be only from $200 to $500. On the other
hand, it would be easy and rather desirable to buy better
things and make the foregoing list run to $1,200.
THE MODERN HOSPITAL
483
Conducted by ANNIE W. GOODRICH. Dean Army School of Nursing
and CAROLYN E. GRAY. Principal City Hospital School of
Nursing. Blackwell's Island. New York.
Please address items of news and inquiries regarding Department of
Nursing to CAROLYN E. GRAY'. Principal City Hospital School of
Nursing, Blackwell's Island, New Y'ork.
HOW THE COLLEGES CAN HELP IN THE TRAINING
OF NURSES*
AflBliation of Training Schools with Universities Found to
Be of Mutual Benefit — Emergency Preparatory Course
Given at Vassar Camp an Unusual Success.
Bv ISABEL M. STEWART. R.N., A.M., Department of Nursing and
Health. Teachers' College, Columbia University, New York City.
The war is bringing a great many changes in all
branches of education — and none more interesting and
significant than those ■which are taking place in the field
of nursing education. Until very recently, nursing has
been more or less a cloistered profession, and nursing
schools have been practically isolated from all other
systems of education. Nobody kne-w -what we weve en-
deavoring to accomplish in our training schools, and we
did not know very much about -what -was going on outside
our own very busy institutions.
Without financial resoui-ces, and without any of the
machinery of a modern educational institution, we have
been struggling on alone, trying to make the system of
training established thirty or forty years ago in hospital
training schools fit the rapidly increasing demands of a
modern scientific and technical profession. Had we been
more closely in touch wdth the currents of educational
progress stirring in the world outside, we should probably
long ago have done as so many other private professional
and technical schools have done — we should have simply
admitted that the job was getting too big for the individ-
ual hospital school and have asked to have part of the
work taken over by public institutions which were better
equipped to carry it on. In that way we should have
secured, not only relief from our almost impossible task,
but a far greater measure of understanding and appre-
ciation of our work on the part of the great body of
educators and the general public.
The fact is that the public has never realized the mag-
nitude of the problem with which the hospitals have been
struggling in the education of nurses nor has it grasped
the relation which this training bears to the safety and
welfare of the nation. There has been much criticism,
but no real appreciation of the fact that the whole burden
of preparing these workers for the service of the state
and the community has fallen largely on private and
philanthropic institutions, with no assistance at all from
educational funds such as are appropriated for the train-
ing of teachers and other technical and professional work-
ers. Millions of dollars of public money have been spent
* Read before the Twentieth Annual Convention of the American Hos-
pital Association, Atlantic City, N. J., Sept. 24-28, 1918.
on training students and teachers of agriculture, for in-
stance, but not a cent has ever been given from the public
treasury to promote the education of nurses. The reason
probably is that, until we found ourselves nearly swamped
by the problems of the war, we have never thought ser-
iously of asking for public help, and we have not made
our work and our needs known either to the public or to
the educational institutions who might have helped us.
Our comparative isolation from other educational insti-
tutions and certain of the older features of our educa-
tional system have also made it difficult for us to attract
into our schools very large numbers of highly qualified
students such as those who are found in the colleges and
the institutions of higher education in this country. This
seems strange, considering the remarkable development
of the nursing field in recent years and the quite unusual
opportunities for well educated women in many important
branches of nursing service. College women have been
flocking into business and industry and into many other
new fields which do not compare with nursing in social
importance or human interest. They have often expressed,
great interest in nursing work, but, after inquiring about
the length of training, the small amount of time given
to study, the long hours of hard practical work, and other
conditions of hospital service, they have hesitated and
very often have chosen other less attractive vocations.
Long before the war, however, certain steps had been
taken to secure a closer cooperation between nursing
schools and universities, so that a sounder basis could
be established for the training of nurses. There was
never any idea of extending this system to all schools of
nursing, but there was a hope that in this way we might
select and prepare a larger number of thoroughly qualified
women to serve as teachers, organizers, and executives
in the higher branches of professional work. We have
always been pretty well supplied with rank-and-file work-
ers in nursing, but we have been expanding so rapidly
that we have never had nearly enough competent leaders
and officers, and our hospital and public health work has
often been seriously crippled by this deficiency.
These efforts in tying up our work with higher educa-
tional institutions have been on the whole very successful.
Nursing courses of a number of varied types had already
been established in about sixteen colleges and universities,
and the movement was slowly but steadily taking root.
There was, however, little or no prospect of any imme-
diate or general readjustment in our system of training.
The colleges were wrapped up in their more purely aca-
demic interests, and, not being closely in touch with actual
conditions among the great masses of our citizens, they
did not clearly grasp the vital importance of the work
which nurses have been doing in many branches of public
service. The hospitals were on the whole satisfied with
things as they were, or were inclined to endure the evils
of which they knew rather than to fly to others of which
they knew not. Both are extremely conservative insti-
tutions and not likely to take such a radical step without
some special push.
Then came the war. It is a well-recognized fact, drawn
from the history of hundreds of years, that, whatever the
devastating effects of war may be in other fields of
activity, its effects on medical and nursing work have
usually been highly beneficial. Indeed, the great periods
of progress and reform in nursing and hospital work have
practically always followed as a result of the experiences
of war or some other national calamity. In the first
place, just as the thought of war fires the fighting instinct
in men, so the suffering of war and the wholesale de-
484
THE MODERN HOSPITAL
struction of human life quickens the nursing instinct in
women. Whatever may have been their previous pursuits
and interests, they see at once that this matter of con-
serving human life is the fundamental thing, and many
of them are willing to throw aside years of training in
other fields to help in the only thing that seems really
to matter, the relief of suffering and the saving of lives.
Of course, a number of those who are clamoring to do
"war" nursing are of the emotional, sentimental type, but
a substantial proportion are fine, wholesome, intelligent
girls and women who, when they see the need, are willing
to do anything to prepare themselves for real service.
Among the very first to volunteer for nursing work
were great numbers of college women, and the question
was how we could make the best use of their excellent
previous preparation and their known qualities of leader-
ship in organizing the great new nursing army which
must be raised to meet the needs of the military and
naval service. The army and navy were drawing heavily
upon the men's colleges for officer material, and it seemed
to be quite the fitting and logical thing that the women's
colleges should supply at least a fair proportion of the
women who might be prepared to train the new recruits
and to help in organizing and directing nursing work in
both military and civic hospitals.
The National Committee on Nursing felt it necessary,
in view of the urgency of the situation, that such students
be trained as rapidly as possible; so arrangements were
made with a number of representative hospitals to give
credit for previous college training and push these stu-
dents through in about two years instead of three. A
general appeal was then sent out to the colleges to urge
their students and graduates to enter at once for the
nurses' training on this basis. The appeal met with a
very cordial response. The need was so evident and the
desire for real practical service was so keen that a con-
siderable number entered last summer, several hospitals
arranging special summer preparatory courses to let them
get started at once.
But the colleges were not satisfied simply to send their
students into hospitals. They began to inquire whether
they could not do something more to help, and several
of them in their zeal made the mistake of thinking that
they could themselves prepare their students by short
theoretical courses to go to the front as "war" nurses.
The trustees and faculty of Vassar college were e.xceed-
ingly anxious to use their great plant and its many edu-
cational resources during the summer to further war pre-
paredness in some definite way and, in looking over the
whole field of women's work, decided that nursing was
the most important and the most immediately necessary
branch of women's service in war. The idea of a summer
preparatory course in nursing for college women was
suggested by the summer military training camp at
Plattsburg for men. Mrs. Blodgett, one of the Vassar
trustees, immediately consulted with Miss Nutting, chair-
man of the committee on nursing of the Council of Na-
tional Defense, and was assured that the idea was an
excellent and practical one. It was formally approved
by this committee and by the Red Cross, the latter organ-
ization assisting substantially in financing the course as
an experiment in war service training. A committee was
appointed from the National League of Nursing Education
to help in working out the curriculum, and the National
Committee on Nursing gave constant advice and assist-
ance in developing the other features of the plan.
The experiment all through has been a great success.
The idea of the nursing-preparatory course outside the
training school was not in itself new, but it had never
befoi'e been carried out on such an extensive scale, with
so many hospital affiliations and with such a highly
selected body of students. The total number of students
taking the Vassar course this summer was over 439.
They are all graduates from colleges of good standing,
115 colleges being represented in the whole group. They
come from practically every state in the country with a
small group from Canada. Their ages range from 19 to
40 years, the mean age being between 24 and 25 years.
They represent a wide variety of occupations, but over
one-half of them come from the teaching profession,
which gives some hope of relief for our serious scarcity
of instructors in training schools.
They are a splendid body of women. The members of
the faculty who have been working with them, as well
as the superintendents of nurses, physicians, and college
professors who have visited the classes and seen the
students at work, all agree that they are an unusually
keen, earnest, hard-working and attractive group of young
women. They compare very favorably with professional
students in any field, and most of them would be a decided
asset in any profession.
One could not fail to be impressed with their fine spirit.
It showed itself in the way they buckled down to work,
in their ready acceptance of the strenuous program and
somewhat restricted personal liberties which were con-
sidered necessary for the accomplishment of the work, in
the cheerful way they rose for setting-up e.xercises at
5:50 a. m., and the zeal they showed in making envelope
corners and wielding damp dusters. No doubt, there will
be some in the group, as in all groups of probationers,
who will fall down in their practical work, some who will
prove "quitters" or "slackers," and some who will never
be able to adapt themselves to the exacting demands of
the hospitals; but, on the whole, most of them give the
impression of being the kind of people we like to see
coming into nursing schools — wholesome, intelligent,
eager, energetic, and full of the spirit of service.
The course was arranged pretty much on the lines of
the regular four-months preparatory course given in the
better hospital ti'aining schools, except that there could
be no practical work with patients in the three months
while the students were at the college. The theoretical
work was more intensive during this period, covering all
the usual preparatory subjects — anatomy and physiology
(60 hours), bacteriology (48 hours), chemistry (48 hours),
hygiene and sanitation (30 hours), elementary materia
medica (24 hours), nutrition and cookery (60 hours),
elementary nursing and hospital economy (60 hours), and
the history of nursing (10 hours). In addition, students
who had not had college courses in psychology and social
science were expected to take the elective courses in these
subjects of 30 hours each. A number also elected the
course in physiological chemistry, which was off'ered for
those who had already studied general chemistry.
The students had practical, as well as theoi'etical, work
in elementary cooking and nursing procedures in the
college laboratories, which were well fitted up for the
purpose. Though they could not be trained in the exact
methods of the different affiliating hospitals, they did
cover most of the practical work given in the ordinary
hospital preparatory courses, and it was expected that
they would require only a few demonstrations in the
hospital's own methods to enable them to go ahead with
the regular work in the wards. They entered the hos-
pitals on the status of probationers in the beginning of
the fourth month of training, the only difference being
that their theoretical work was already covered and that
they would be expected to spend the last month largely
THE MODERN HOSPITAL
485
in intensive practical worlv under the careful supervision
which all probationers require. At the end of this time,
they will be given their uniforms (if accepted) and will
proceed at once with the remaining work of the junior
year. Since they are all entering for the two-year course,
their theoretical woi'k of the intermediate and senior
years will have to be combined and the periods of exper-
ience in the different services somewhat shortened to
provide for the usual all-round training.
The arrangements with the affiliating training schools
have, on the whole, worked out satisfactorily. It was
considered wisest to concentrate the students in a few
hospitals rather than to distribute them over a great
many. A number of representative schools of various
types were selected from various parts of the country,
connected with hospitals with good clinical facilities, good
traditions of nursing work and good standards of instruc-
tion. These schools wei'e invited to coopei'ate with Vassar
College on the basis outlined above, and most of them
accepted gladly, stating the number of students they
could take. A number of the prominent schools of the
country were not included in the final list, as they were
not able to reduce their three-year course of training
either on account of state laws or because they preferred
not to make any change in their system. Wherever any
hospital asked to have its nursing school included in
the list and gave some assurance that it had the facilities
for giving a good training, it was added, unless, as in
some cases, the application came too late.
Students had absolute freedom of choice in the selection
of their schools, except for the fact that the better-known
schools in the list were quickly filled up and consequently
a second, and sometimes a third or fourth, choice had to
be made. Whenever any student expressed a preference
for a school not on the list, she was at pei'fect liberty
to enter that school if it proved to be of good general
standing.
A copy of the Vassar application blank, which included
a statement of the student's educational qualifications,
physical condition, and other information of a general
character, was sent at once to the first training school
selected, and the superintendent of nurses accepted or
i-ejected the student as she would any other applicant.
If rejected, the blank was sent to the school of second
choice and so on. Dean Mills, who has shown from the
beginning an unusual appreciation of the hospital side
of the problem, has strongly discouraged any changing
about, once the decision was made and the student's appli-
cation accepted. Practically all the arrangements were
made before the new Army School was established; so
very few are entering the military hospitals.
The results show a decided preference for hospitals
located in the larger eastern cities, particularly in New
York. By far the largest groups go to the big municipal
hospitals like Bellevue, New York, which took about sixty,
the City Hospital, New York, the Philadelphia General,
the Cincinnati General, and others of the same type. It
seems evident, therefore, that, if most cities or states wish
to secure such applicants for their own schools, they will
have to establish their own preparatory courses and con-
nect up with the local hospitals.
Many very interesting features of the Vassar course
might be described, but it will be of special interest to
hospital people to know the efforts which were made to
prepare the student for the life and duties of the hospital.
In all the courses, but especially in the laboratory work
in the sciences, cooking and nursing, definite attention
was given to training the students to observe details, to
use their hands, to plan ahead, and to be systematic and
orderly in their work. To help in establishing good per-
sonal habits, they were all required to make their own
beds, to dust and tidy their rooms, and to keep their
dormitories in a neat and sanitary condition. Regular
room inspections were made by the nurses on the faculty,
and records were kept of the students' standing on these
and other matters relating to dress and deportment.
Students were required to wear the uniform of the school
to which they were assigned, and high-heeled shoes, ex-
treme coiffures, jewelry, and other small vanities were
gradually eliminated. Hospital hours for rising and re-
tiring were enforced, and some of the commoner observ-
ances of hospital etiquette were observed.
Undoubtedly all these things contributed to the splendid
morale of the students, but the main thing was that they
were exceedingly happy in their work and in their per-
sonal relationships with their instructors and the many
other officers of the camp. Their living conditions were
good, their health was very well looked after, excellent
provision was made for sports and other athletic activ-
ities, and the social life of the whole large family was
exceedingly pleasant.
Besides the inspiration which a large group like this
gets from starting in together, there is the great advan-
tage of being launched into their future work with a cer-
tain impetus and enthusiasm. Most nursing students
who drop out during the early stages of the hospital
course do so because they fail to catch the meaning of
the whole thing — they do not clearly see the goal which
lies at the end of the long up-hill climb. It was interest-
ing to see the gradual change in the view-point of these
students, the rising appreciation for their new vocation
which followed the various talks by leading men and
women in nursing and health work. Many of the Vassar
group had entered with the idea of going back to other
lines of work after the war, but, unless their present
enthusiasm becomes chilled sadly, there is every reason
to believe that most of them will stay in the profession
in educational or public health work.
There has always been a question as to whether in-
structors who are not themselves nurses or physicians
connected with a hospital would be able to bridge the gap
between the .class-room and the hospital ward and make
their teaching really practical and effective. The larger
number of professors and instructors at Vassar this sum-
mer were recruited from the many different colleges. Most
of them were not doctors or nurses, and indeed many, to
begin with, had very little knowledge of special nursing
needs. But they were highly trained specialists in their
own branches and, with some help from the nursing and
medical menibei-s of the faculty, they very soon found
out what subjects needed emphasis and what kind of
applications would be most helpful for these students.
With the exception of practical nursing, materia medica,
and the history of nursing the main part of this work
can pi'obably be better handled on the whole by expert
teachers of bacteriology, chemistry, hygiene, dietetics,
etc., than by the busy practicing physician or the nurse
instructor in the hospital, who is usually expected to cover
a dozen diff'erent subjects. The main thing is that they
should be interested enough to make a special study of
the phases of nursing to which their subject specially
applies and that they should be good teachers in sympathy
with this group of students. The teacher of practical
nursing will then be responsible for connecting up the
various sciences with the practical problems of the hos-
pital, thus unifying the whole body of knowledge and
making it more concrete and practical.
Although many modifications will probably have to be
486
THE MODERN HOSPITAL
worked out later, and although it would not be possible
or desirable to carry out all the features of the Vassar
Training Camp under other conditions, there is no ques-
tion but that this plan offers a good practical basis for
cooperation between colleges and nursing schools. Four
other courses of a somewhat similar type were carried on
this summer as a result of this suggestion and many
other colleges, universities, normal schools, and technical
schools are inquiring about the possibilities of working
out the same kind of an arrangement in different parts
of the country.
The American Council on Education, in cooperation
with representatives of the Committee on Nursing of the
Council of National Defense, the Army School of Nurs-
ing, the Vassar Training Camp, and the Association of
Collegiate Alumnae, is taking up the whole question with
a group of selected colleges, and is ready to push ahead
with plans and arrangements as rapidly as possible. A
pamphlet,' outlining the general principles on which
the work should be developed, has been issued by the
Committee on Nursing of the Council of National De-
fense, Washington, D. C, and this may now be secured
by any one interested in the subject.
The main arguments for the nursing preparatory course
in the colleges are:
1. It will relieve some of the pressure on hospital
training schools during the war. On account of addi-
tional classes and depleted staffs, it has been almost im-
possible to cai-ry on proper teaching in many schools and
yet the need for this work was never more urgent and
imperative.
2. It will relieve the hospital of the most expensive
and difficult part of the nursing course, and the students
who enter will be better prepared to start at once on
their duties in the hospital. The poorer ones will be
largely weeded out before they come to the hospital.
3. A thorough, intensive course of preliminary instruc-
tion will give a sounder preparation for future nursing
work, and it is hoped that, on this acount, it may be
possible to push students through a little more rapidly.
4. By connecting with an academic institution of rec-
ognized standing, a better class of women will be at-
tracted into nursing schools, and much larger numbers
can be recruited for the special needs of war time, as
well as for the permanent field.
5. It will release additional housing accommodation in
the nurses' home and so make it possible for the hospital
to take in and train more nursing students for its own
and the country's use.
It is not at all necessary that students should be college
graduates, but they should have good high school training.
It would be essential, of course, that the educational in-
stitution offering such work as this should be of recog-
nized standing, and the training school authorities should
be quite satisfied that the instruction and conditions of
work are of the right kind before making any arrange-
ments to turn over their preparatory work. Unfoitunate-
ly, a few institutions have already ventured into this field
without consulting any recognized representatives of
nursing schools and without knowing anything about the
standards of good nursing training. Such courses will
undoubtedly attract numbers of misguided people, and
even training schools may be misled into recognizing their
work if this is not made perfectly clear.
The main thing which must be absolutely insisted upon
^Preparatory Courses for Nurses in ColleKes and Universities— A
War Measure.
=A copy of this curriculum can be obtained by sending one dollar to
" - Isabel M. Stewart. Department of Nursing and Health. Teachers'
in any course of this type is that it must be worked out
in the closest cooperation with recognized representatives
of the nursing profession and in harmony with the stand-
ards which are generally accepted in the best nursing
schools. This is particularly important when it comes
to the selection of affiliating schools. It is suggested
that the general standards outlined in the Standard
Curriculum for Nursing Schools" published by the
National League of Nursing Education, would be a
fairly reasonable requirement for such schools, or some-
thing approximating such a standard. In war time, of
course, conditions in even the best hospitals are not nor-
mal, but, if training schools could be released from even
a part of the preparatory period of training, it should
be possible for them to concentrate more on the rest of
the course and thus give a good all-round training.
In some places affiliations with colleges are also being
made in the latter part of the third year, for students
who wish to specialize in teaching or in public health
nursing. This is another plan which is being pushed
ahead because of our war needs and which will probably
be worked out more fully during the coming year. All
kinds of conditions are changing under the stress of the
great emergency, and no one can foresee the adjustments
which may have to be made from day to day and month
to month. Some of these will be temporary, but it is
probable that out of our new experiences we will be able
to build something which will carry us forward a long
way toward a more ideal system of nursing education.
The great thing for us now is to hold ourselves open
to every new suggestion which will help in getting many
thousands of trained women into the field at the earliest
possible moment and to utilize every agency which will
help us toward that end.
SUMMER PREPARATORY COURSE FOR NURSES
GIVEN AT WESTERN RESERVE UNIVERSITY*
Steps Taken in Establishment of Course — Outline of
Curriculum — Advantages and Disadvantages
By CLARIBEL a. wheeler, R.N.. Principal, Mt. Sinai Hospital
School of Nursing, Cleveland, Ohio.
The preparatory course for student nurses given this
summer at Western Reserve University originated in the
mind of the president of that university, who, interested
in the education of nurses and reading of the course being
planned for Vassar College, wished that something similar
might be accomplished at Western Reserve. This desire
became known to the League of Nursing Education of
Cleveland, with the result that immediate interview was
sought with the college president and in the twinkling of
an eye the project was launched.
It was not deemed advisable or practical to open the
course to college graduates exclusively, as Vassar was
recruiting college women from all over the country for
the course to be given there; consequently a plan on a
much smaller scale was decided upon. The minimum en-
trance requirement was made a high school diploma, and
students were recruited for schools of nursing of Cleve-
land.
A committee from the League of Nursing Education,
in conference with members of the faculty of Western
Reserve University, planned the curriculum and acted as
an advisory board for the course, a director being ap-
pointed to manage the details.
ColleKe,
W. 120th St., New York City.
•Read before the Twentieth Annual Convention of the American
Hospital Association, Atlantic City, N. J., Sept. 24-28, 191S.
THE MODERN HOSPITAL
487
The greatest obstacle that lay in the way was the
financial log. How wei-e we to meet the expense of such a
course? An appeal was made to the Mayor's War Ad-
visory Board of Cleveland, who recognized the value of
such a course as a war measure and graciously appro-
priated the necessai-y funds.
Instructors were secured from the faculty of Western
Reserve Medical College, Adelbei't College and the College
for Women, with the addition of two nurse instructors
from Cleveland schools of nursing.
Students were recruited directly through the univer-
sity, which announced the course in their summer school
bulletin, and through recognized schools of nursing of
Cleveland. The nursing section of the woman's committee
of the Council of National Defenise gave valuable assist-
ance with the recruiting. The Vassar recruiting com-
mittee also referred to us applicants who did not meet
their requii-ements or who were too late for registi'ation
in the Vassar course.
It was impossible to give the course publicity until after
the first of May, when arrangements had been definitely
made. In spite of this fact, a large number of applica-
tions was received. It was impossible, on account of lack
of facilities, to take more than one hundred students.
Consequen*'lv, one hundred applications were accepted, and
eighty-eight of this number reported for registration.
The course, which opened June 17 and closed August 24,
was given in ten weeks and was divided into two terms of
five weeks each. During the first term, lectures were
given at the Medical School, and during the second, at
Adelbei-t College.
Students were required to select the Cleveland school
which they desired to enter and were assigned to that
school at the time of entrance. The hospitals provided
room, board and laundry during the ten weeks. The stu-
dents lived under the same regulations as the other pupils
in the school. Uniforms were not worn, as many had to
go considerable distance through the city to classes. Each
student paid for all text books, laboratory fees, car fare,
etc. Those who wei'e not affiliated with any school of
nursing in Cleveland were required to pay a tuition fee
of $25 and to meet their own living expenses.
The students were a bright, enthusiastic, patriotic group
of young women, mostly fresh from school or from teach-
ing. Seven of them were college graduates; two had
completed three years of college; four had finished one
year of college; one was a normal school graduate; seven
had taken several years of normal work; and the remain-
ing sixty-seven were high school graduates.
■ Of the eighty-eight who entered, eighty-three were
assigned to hospitals, four to army schools, and one ex-
pected to enter an out-of-town school. Eleven dropped
out for various reasons before the completion of their
ten weeks. The others are now being given intensive
training in nursing theory and ward practice in the
hospitals, where they have the status of probationers in
their third month.
The subjects given were: anatomy and physiology, 75
hours; bacteriology, 45 hours; chemistry, 30 hours;
drugs and solutions, 30 hours; history of nursing, V6
hours; household economics, 30 hours; hygiene and sani-
tation, 20 hours; nutrition and cooking, 45 hours; sociol-
ogy, 10 hours; total, 300 hours.
On account of limited time, principles of nursing and
procedure was not given. The cost per capita of the
course was about $40, not including any of the expenses
borne by the students themselves.
Centralization of schools for preliminary preparation of
nurses is a thing to which we are looking forward. The
summer courses given at Vassar, Western Reserve, and
several other colleges seem to be the beginning of such
a movement. A discussion of a few of the advantages
and disadvantages as demonstrated in our course at West-
ern Reserve may not be out of place in this report.
The disadvantages are easily discernible:
1. The crowding of so much theory into so short a time is one of
the greatest. The instructors all made this criticism, sayins that it
was impossible to do justice to their subjects. It is also a question
whether science taken in such lar(?e doses will be properly assimilated,
especially by pupils who have high school training only.
2. For the students who came directly from a school year of hard
mental work the heat of summer was difficult. It is doubtful if they
did the best work of which they are capable.
3. The students were greatly handicapped by having to travel
considerable distance to classes, thus losing valuable time.
4. It was* also a disadvantage having the students so separated
and living under different regulations and discipline in the different
hospitals.
The last two difficulties were ideally met at Vassar by housing the
students in dormitories on the campus, where they were all under the
same regulations and living conditions.
The advantages are obvious:
1. As a war measure, it was most successful, for it supplied to
the schools of nursing of Cleveland an extra class of students.
2. It relieved all the hospitals of one of their greatest burdens,
that of the cost of instruction,
3. The students had at their disposal the splendid facilities of the
college laboratories, which are far superior to any found in hospitals.
T^or example, the anatomy and bacteriology laboratories at Western
Reserve Medical College, with their wealth of material, offered advan-
tages which could not be equalled.
4. Instruction was given by expert teachers, who were especially
interested in nursing education and who endeavored to correlate their
subjects to nursing.
5. The fact that the course was given in connection with a large
university attracted a group of intelligent, patriotic women.
6. Reports are being received that these students are doing unusually
good work and that their knowledge of bacteriology, hygiene, household
economics and history of nursing has provided them with a real back-
ground for the work which they are undertaking and has given them a
greater appreciation of the conditions which they are meeting than has
been evinced by those who have received this grounding later in their
The results on the whole are pleasing; the conclusion is,
therefore, that the idea of centralization for preliminary
preparation is not an erroneous one and that the estab-
lishment throughout the country of longer and more per-
manent courses of this character is desirable.
Abstract of Discussion
Miss Maude Landis, New Haven, Conn.: The Connecti-
cut Training School is one of the oldest training schools,
having been established under a separate charter in 1872.
During the past few years it has begun a systematic
development, assisted tiy the Yale Medical School and
the New Haven Medical" School, which has necessitated a
new organization. The Yale Medical School has recently
been ve'-y richly endowed, and it was, of course, neces-
sary that additional facilities be added to the hospital.
The Connecticut Training School is the nursing depart-
ment that has to do with the care of the sick in the
New Haven Hospital, and the hope is that it will be the
department of nursing of the Yale University. This is
a peculiar situation, for Yale University is not a co-
educational school. The only women who attend Yale
University are the graduate students, and, as the require-
ments for entrance into training schools are not of post
graduate qualifications, exceptions have to be made for
these students. Yale Medical School does not care to
assume the financial responsibility attached to making
the training school one of its departments. It is, how-
ever, quite willing for the training school to go in as a
department of Yale University, and we are looking for-
wa7"d with very great interest and anticipation to the
result of this affiliation. Some publicity has been given
to the plan, calling attention to the nursing needs, and
this, together with the popularity won by nursing dm-ing
the summer, has made it possible for us already to raise
our entrance standards. The curriculum, as we have
outlined it, partakes very much of the content of that
given at the summer course at Vassar. We have within
our call the instructors in the various departments at the
university; so the course contemplated for our nurses
is going to be quite wonderful. What was given in three
months or thirteen weeks at Vassar we will not try to
give in thirteen weeks in our school, because we will have
the pra-tical coordinating with theoretical work. _
The interest shown by everybody has made it quite
possible to effect changes which, perhaps, at other times,
or without this friendliness, would have been quite im-
possible. The hospital has a capacity of 275, with the
THE MODERN HOSPITAL
usual number of services in a general hospital. We have
just 100 nurses, but, as time goes on, we see no reason
why we cannot have the full quota, which would be about
130 nurses for that school. We have, aside from the uni-
versity instructors, our own training school instructor
and two practical instructors. We plan not only to have
the theory well taken care of, but also to outline just
what might be taught in the different wards and then
have the head nurses responsible for all the instruction
that their wards give. The few head nurses we have,
have been employed with this in view. The correspond-
ence has brought out that always — that they have a
teaching responsibility — and, in that way, perhaps, there
will not be undue attention given to the theoretical phase
of our work.
Only a Scrap of Paper— But, Oh, What it Means!
Englishmen can hurry with a skill and an efficiency
that takes even an American's breath away. When it
comes to their fighting men they break all speed records.
Thousands of men have died in the mud of Flanders —
thousands have been wounded and sent home — but thou-
sands have had to lie in those "Halls of Glory," the base
hospitals behind the lines; and suffer — beyond the con-
ception of any man — before the tide turns back towaixls
life, or slips out in the gray dawn of Flanders, never to
flow back. And the British fight to save those suffering
men just as stubbornly as they fight to beat the enemy
beyond the heavy cannonading a few kilometers away.
As these men suffer and fight for life in the long white
wards, they need so many things to help; and often it is
just someone they love to touch, to smile at, to take hold
on life once more — to wake up after moaning intervals of
unconsciousness and find her sitting close to the narrow
bed, smiling at you — and it is done just as quickly as that.
After the doctor's rounds, he sends a telegram asking
her to come to such-and-such a base hospital to see Pri-
vate . That very evening, perhaps, in Devon, where
the sun sinks low, a small boy comes running and pufiing
up the lane waving the precious paper; the door under the
thatch stands open. She is there, waiting, as the women
are waiting the world over today and the message says
"Come." That is all she needs — that telegram is pass-
port, railroad ticket, bus-fare, channel crossing, entrance
to the war-zone, space on troop-train, pass into that long,
low building where her "love lies bleeding."
Yes, it's a wonderful high-way the British build from
the aching ward in Flanders to the cottage in Devonshire.
.Just a telegram — no bewildering officials, no hours of
waiting outside important doors — just a telegram; and the
next evening at sunset, she is sitting by her man in
Flanders as he sleeps for the first time because the tide
has turned.
Just a thin bit of blue paper — just a telegram.
June Richardson Lucas.
St. Cloud is one of the most efficient Canadian hospitals
in France; it was given by the Canadian Government for
the treatment of French poilus, and is under dual con-
trol. The French Government supplied the huts and the
Canadian Government furnished them. Each hut is
named after some province or city in Canada. Each hut
averages twenty-eight beds, and GO percent of the staff is
French-Canadian, while the full staff numbers 223. The
officer in command is Lt.-Col. Casgrain, of Windsor, Ont.
— Hospital World, Toronto.
Go through your ward about 2 o'clock in the morning
and put an extra blanket on the seemingly restless pa-
tients. Notice how quickly they settle down to sleep
again. — Marie Robertson, R. N., in The Nurse.
HEALTH
AND
MODERN INDUSTRY
Conducted by BARROW B. LYONS
Superintendent Delaware Hospitah ^ilmin^ton, Del.
ORGANIZED PREVENTION OF SICKNESS
How the Dennison Manufacturing Company Keeps Its
Twenty-three Hundred Employees in Good
Working Condition
By J. J. WEBER, Associate Director. Boston Dispensary, Boston
To hospital executives and workers in the health field
generally, the city of Framingham, Mass., is far-famed
as the seat of the community health and tuberculosis dem-
onstration now being- carried on under the auspices of the
National Tuberculosis Association. To the public at large
—the users of tags, pasters, Christmas seals, paper nap-
kins and fancifully decorated crepe paper table cloths —
Framingham is known as the home of the Dennison Man-
ufacturing Company, "The House of Ten Thousand Ar-
ticles." Neither the public at large, however, nor the
health workers, generally speaking, are familiar with one
of the most interesting and vital departments of this man-
ufacturing establishment — the department of industrial
service. This department is being built up as part and
parcel of a going concern solely because the management
is convinced that its activities make for efficient produc-
tion. If time and money are being profitably spent in
maintaining the integrity and prolonging the life of the
machinery of the plant, surely, arguing a fortiori, time
and money should be spent in maintaining the well-being
Fig. 1. The treatment room of the Dennison Manufacturing Com-
pany, with the coryza room, equipped for the treatment of head
colds, at one side and the gargle room at the other.
and promoting the efficiency of the more important factor
of production — the worker.
The industrial service depai'tment of this concern, now
employing twenty-three hundred workers, is presided over
by the Industrial Service Committee, made up of the treas-
urer of the company, the physician in chai'ge of the med-
ical clinic, the employment manager, the educational di-
rector, the registered nurse and the manager of the lunch
THE MODERN HOSPITAL
489
room. Various lines of activities are carried on, including
educational classes, recreational activities, a rest room for
women employees, a lunch room and a boarding house for
girls. This article, however, will confine itself to the de-
partment's activities in the interest of the health of the
workers.
These activities, of course, include the customary first
aid and care of minor injuries and illnesses usually found
in any manufacturing plant providing medical service for
its employees. Anyvi'here from forty to sixty of the
twenty-three hundred employees visit the clinic daily to
have a slight cut bandaged, a toothache relieved or a
slight cold treated. But this medical care, important as
it is in relieving suffering, is quite subsidiary to the main
Fig. 2. The women's rest
pany, where employee?
loss of pay.
purpose of the company's health work. That purpose and
controlling principle is the prevention of disease and the
safeguarding and promotion of health. What are some
of the ways in which this principle finds practical applica-
tion?
In its medical work the industrial service department
is not content merely with treating a wound, but every in-
jury, however slight it may be, is reported immediately
on a standardized blank form to the safety engineer,
whose single task is the safety of twenty-three hundred
workers. It is his responsibility to devise safety appli-
ances that will prevent the repetition of accidents. Tang-
ible evidence of his ingenuity may be seen on every hand
by anyone whose privilege it is to visit the plant. The
character of the products of the Dennison Manufacturing
Company are fortunately such as to present few health
hazards. The principle danger is probably from lead
poisoning in the printing establishment, but here the
hazard has been reduced to a minimum by the installation
of efficient devices. Whenever, moreover, a new workman
enters the printing department he is given a card telling
him how to prevent lead poisoning.
PRECAUTION URGED UPON THE WORKERS
The employees are taught not to regard the common
cold lightly, but are urged upon the slightest symptom to
see the physician at the clinic. For the treatment of head
colds a small anteroom, just off from the treatment room
of the clinic, was built and equipped for aiding in the
treatment of such colds by the inhalation of vapor rising
from a pint of steaming water into which a teaspoonful
of formaldehyde has been placed.
The preventive work of the department is further em-
phasized by the fact that curative work is done only
where brief treatment is called for. When an employee's
condition requires prolonged treatment, he is referred to
his own physician, to the out-patient department of one
of the Boston hospitals or to one of the hospitals in
Framingham. The company has no contract arrangement
with any of the hospitals in Framingham for the medical
care of its employees. It is, however, free to refer to
them any of its employees requiring hospital care. Em-
ployees who come to the company's clinic complaining of
trouble with their teeth are given temporary relief and
an effort is made at once to arrange an appointment with
the employee's dentist.
Another important aspect of the preventive work is the
sanitary inspection made every week by the doctor and
the nurse. Weekly rounds are made of all the toilets,
wash stands, and dressing rooms. The floors of all of
the buildings are carefully inspected and all insanitary
conditions are reported immediately either to the clean-
ing department or to the sanitary engineer.
Unremitting effort is made to educate the employees
in the fundamental principles of good health. Each year
a little booklet, giving in simple language the laws that
should be observed to maintain good health, are distrib-
uted among the employees. As one of the principal prod-
ucts of the company consists of tags of every sort, there
is especial appropriateness in which the physician in
charge of the clinic is now working out for the distribu-
tion about once a month of health tags printed in differ-
ent colors. These tags will deal simply with such subjects
as general health, head colds, care of the teeth, tubercu-
losis, proper posture, and safety first. The subject mat-
ter of the first tag will illustrate the character of this
health propaganda.
1. Eat plain, wholesome food and eat slowly. The
more your teeth work the less vour stomach will have to
do.
2. Drink plenty of water.
■3. Get at least seven or eight hours of sleep.
4. Bathe the body at least twice a week with soap
and warm water.
5. Avoid constipation, as free action of the bowels is
necessary daily.
6. Brush the teeth twice daily, using some good dental
cream. If your teeth need attention, see a dentist at
once.
7. Avoid spitting; it is filthy and spreads disease.
8. Use the bubbling fountain for drinking, but do not
touch the metal.
9. Have a complete physical examination by a doctor
at least once a year. ".An ounce of prevention is worth
a pound of cure."
Every precaution is taken to prevent the spread of con-
tagious disease among the employees. Any employee who
has a contagious disease is not permitted to return to
work until he or she has first been seen by the physician
in charge of the medical work at the plant.
In its preventive work, the company has not as yet
adopted the policy of having a physical examination made
of all its new employees or of having periodical medical
examinations of all of its old employees. An effort, how-
ever, is being made to persuade as many employees as
possible to have a thorough physical examination made;
and thus far two or three hundred of these examinations
have been completed. A thorough physical examination
is given all employees who are assigned to heavy work
and all young men and women who are of working age,
but under sixteen, are also examined when first employed.
REST ROOM AN IMPORTANT FEATURE
One of the outstanding preventive measures adopted
by the company is the provision of a rest room for women
490
THE MODERN HOSPITAL
employees. This is a spacious, comfortably furnished
room located just opposite the clinic. There are a dozen
couches scattered about the room where women may rest
during working hours or during the lunch hour with a
measure of privacy through the use of movable screens.
Electric warming pads are available. Employees using
the room must first report to the nurse in charge of the
clinic and are allowed one-half hour without deduction
of pay. Ordinarily the room is used by from thirty to
fifty employees a day and during the extremely hot sum-
mer months, by as many as one hundred and twenty to
one hundred and thirty. This privilege is seldom abused
and in a few instances where it is, a word from the nurse
usually stops the abuse.
The Dennison Manufacturing Company is fully abreast
of the times in its recognition of the important part which
wholesome food plays in the maintenance of sound health.
Most of the employees live near enough to go home for
their mid-day luncheon, but such as are unable to do so
are not left to the mercy of cheap lunch rooms. The com-
pany provides lunch daily for about six hundred and
fifty of its employees, two-thirds of whom are girls and
women. A trained dietitian is in charge of this depart-
ment and every effort is made to provide wholesome, well
cooked food at cost. Thus far, however, no efl'ort has
been made to suggest well-balanced diets nor are em-
ployees taught the relative value of various foods.
As eighty percent of the plant is now devoted to gov-
ernment work, and some of it has to be rushed, certain
departments have night shifts. The physician is not on
duty at night, but is subject to call in case of real need.
Through a series of lectures the night foremen have been
instructed in the use of first aid equipment.
All of this health work radiates from the medical clinic,
an attractive, sunny suite of five rooms, including a large
reception room where the doctor or the nurse receives the
employees who come for advice or treatment, a well-
equipped treatment room, the private offices of the doctor
and the nurse and a small rest room for men employees.
The treatment room, as will be seen from the picture ac-
companying this article, is adequately equipped with ster-
ilizers, medicine cabinet and other necessary facilities.
One of the special features of this room, the coryza room
for the treatment of head colds, has already been referred
to; the other special feature at the other side of the treat-
ment room is the gargle room. The wash stand in this
room is equipped with a special funnel-shaped glass re-
ceptacle leading down into the drain pipe, which prevents
spattering when the gargle is spat from the mouth.
Sterilized cups line one shelf, and a second shelf is pro-
vided for cups that have been used.
The medical work is in charge of a graduate physician,
aided by a registered nurse, whose especial care is the
health of the girls and women employed in the plant.
A Practical Health Guide
An interesting four-page pamphlet entitled "What To
Do To Become Physically Fit," prepared by Surgeon-Gen-
eral Rupert Blue, has been published by the United States
Public Health Service. Its intent is to furnish "In-
formation for Those Disqualified for Active Military Serv-
ice Because of Physical Defects," but it is a practical
health guide to any man physically fit or unfit. It would
pay any employer of labor to place one of these pamphlets
inside the pay envelope of each of his employees.
Copies of the pamphlet may be obtained at small cost
from the Superintendent of Documents, Government
Printing Office, Washington, D. C.
ENLIGHTENED SELF-INTEREST OR SERVICE?
How and Why One Shipbuilding Corporation Immediately
Cared for Its Employees and Their Families in the
Recent Influenza Epidemic
By THOMAS L. LEE HERSEY, Service Manager, Pusey & Jones
Company. Wilmington, Del.
[Note: The following story of immediate and intelli-
gent action on the part of an industrial concern is printed,
not because it tells of something unusual, but because it
gives a very frank statement which illustrates the value
of welfare work, not only in emergencies but at all times.
— Editor.]
When it was evident that the influenza epidemic was
seriously endangering the operation of our plant, we
at once took action to care for our employees. As we
are engaged in building ships for the government, it was
essential that no more time should be lost than necessary.
We at once organized a relief committee. Wilmington
was divided into zones, and the members of our firm
owning automobiles volunteered the use in order that we
might determine how many sick employees we had in
each zone. Volunteer workers visited every employee
who did not report for duty and brought in reports to the
central committee each evening. The patients were re-
ported as needing a doctor or a nurse or needing hospital
care.
In the meantime, we affiliated with another shipbuilding
corporation in the city which had secured a club house
to be used as an emergency hospital. The army ambu-
lance, manned by two of our men, was sent for those
employees needing hospital care, and they were trans-
ported at once to the emergency hospital.
We found many pitiful cases in which everyone in the
family was stricken with the disease, and in each case
we took all of the members to the hospital. In one case
we found the father, mother, and three children all sick
and unable to walk. We wrapped them up in the bed-
clothes and took them in the ambulance directly to the
hospital.
Our reasons for caring for our employees and their
families were threefold. In the first place, our company
is engaged in turning out ships for the government. It
was distinctly to our advantage to get the men back to
work as quickly as possible. By making it unnecessary
for a man to stay home and take care of his sick wife
and family, we added one more worker to our force.
In the second place, we have brought men to the Atlantic
seaboard from all parts of the country — men who are
unknown here, with no credit, no friends, no families to
care for them when they are sick. We felt a large
responsibility for their care after having brought them so
far away from their established bases.
In the third place, we recognized that the situation was
too large for the established hospitals to handle and that,
in order to help the community cope with the unusual
danger which confronted it, we had to do all that was
possible to care for those who came directly under our
supervision. In this way, we not only protected our own
men but helped to prevent the disease from spreading
in the community.
"Sickness in this country is still looked upon as a per-
sonal misfortune. The social conscience has not yet real-
ized that sickness is an economic calamity for which all
members of the community are responsible in varying de-
grees, and for which the whole community pays.'" — Alex-
ander Lambert, M.D., chairman, Committee on Social In-
surance, American Medical Association.
THE MODERN HOSPITAL
491
Conducted by LULU GRAVES.
Please address items of news and inquiries regarding Department of
Dietetics to the editor of this department. Home Economics Building.
Cornell University, Ithaca, N. Y.
FOOD WASTE IN HOSPITALS*
Practical Suggestions for Eliminating Vast Waste in In-
stitutions— Use of Basic Quantity Ration Tables and
Waste Accounting System Superior to Gar-
bage-Can Inspection in Promoting Economy
By CHARLES S. PITCHER. Steward and Deputy Treasurer, King's
Park State Hospital. L. I.
The United States Food Administration has published
a pamphlet entitled "Garbage Utilization with Particular
Reference to Utilization by Feeding." The opening para-
graph of this pamphlet is as follows:
"The American garbage pail, with its twenty-odd billion
pounds of garbage per year, can well be considei-ed one
of our expensive luxuries, and if, through high prices, by
the efforts of the Food Administration or otherwise, our
per capita waste can be reduced by even a small per cent,
no small additional supply of foodstuff's will be available.
"Undoubtedly a large amount of garbage must exist
even when the strictest economy is exercised. The gar-
bage pail can not be entirely eliminated, but it can be
enlisted in the cause of food saving. 'Put less in the gar-
bage pail and take more out.' If all the garbage now
being destroyed in cities of from 10,000 to 100,000 popula-
tion were disposed of by feeding, approximately 30,000,000
pounds of pork, valued at about $5,000,000 would be avail-
able, assuming only 50 percent efficiency. If we add to
this the value of grease and tankage destroyed in cities
of over 100.000 population, we have over $11,000,000 per
annum of potential food values being destroyed."
This pamphlet defines the meaning of the term garbage
as follows :
"The term 'garbage' is a general expression for a purely
local product. It does not designate any definite material
or combination of materials. Its composition and even
its general meaning vary in different localities. As used
■herein, the term 'garbage' will mean all refuse accumula-
tions of animal or vegetable matter which has been in-
tended for use as food for man. It will not include any
material in the nature of ashes, rubbish or refuse, night
soil, dead animals, street sweepings, manure, or similar
materials."
On the fourth page of this pamphlet, under the heading
"Amount of Garbage Produced," you will find the state-
ment:
"Undoubtedly a big factor in the problem of garbage
disposal is the fact that such comparatively small quanti-
ties accumulate each day in every household and that its
nature requires removal at frequent intervals. From
one-half to three-foui-ths of a pound daily, or approxi-
mately 200 pounds per annum, is the per capita produc-
tion in the United States. Obviously the frequent re-
moval of from 1 to 10 pounds of garbage from each resi-
dence is a decidedly more expensive operation than would
be the collection of the same annual aggregate in cartload
lots."
My discussion of food waste in hospitals will be con-
• Read before the Twentieth Annual Convention of the American
Hospital Association, Atlantic City. N. J.. Sept. 24-28. 1918.
fined to refuse accumulation of animal or vegetable mat-
ter which has been intended for use as food for man.
This refuse will be considei-ed as waste, not garbage,
until after it has been weighed and recorded and placed
in garbage cans, after which it will be called "garbage."
It is desirable to make this differentiation so as to dis-
tinguish the unweighed refuse from gai'bage.
In considering food waste in institutions, I will in a gen-
eral way divide food waste into three subdivisions: (1)
waste in purchasing and receiving food; (2) waste in
preparing and cooking food; (3) waste in serving food in
dining rooms.
All unnecessary waste of food supplies should be elimi-
nated, for every pound of food supplies saved is more than
equal to a pound of food supplies purchased, on account
of the saving in cost of production, selling and transporta-
tion. The motto of every hospital or institution should
be: "Raise and save everything possible." The utiliza-
tion of farm and garden products is as important as their
production, for there is no use of producing food supplies
and then wasting them.
Each institution should have sufficient equipment so
that the farm and garden products produced at the institu-
tion, or purchased, which are not necessary for use in
the dietary from day to day, may be stored, dehydrated,
or canned for future use.
An institution should be equipped with dehydrating and
canning appartus so that fruits and vegetables when in
season may be dehydrated or canned in quantities. There
will be great loss in the use of farm and garden crops,
whether they are purchased or produced at the institu-
tion, unless they are properly utilized day by day. This
loss will be greatest in institutions where there are farms
and gardens, and it should be emphasized that neither
farm and garden crops nor any other food supplies should
be forced into the dietary of an institution, but only such
quantities should be used as are necessary for the dietary
from day to day, all the remainder being stored, dehy-
drated, canned or pickled for future use.
Supplies, so far as possible, should be purchased in sea-
son. The specifications on which they are purchased
should be so drawn that the article is carefully and accu-
rately described and should provide that, if the contractor
fails to make proper deliveries, the institution may make
purchase in the open market and recover the difference in
cost from the contractor.
In the purchase of fruits and vegetables it is usually
not practicable to make contracts, as these supplies can
be purchased on competitive bids when needed, with the
exception of such vegetables as can be purchased in quan-
tities for storage.
All supplies when received should be weighed, counted,
or measured, for in this way a very material saving can
be made if dealers are given to short weight. The person
inspecting the supplies should have sufficient training and
knowledge to know what he is receiving, and the specifi-
cations should be so complete that he will have clear
grounds for rejection or acceptance.
To prevent food waste in receiving, there should be
adequate storage facilities so that all food supplies may
be carefully cared for when they are delivered.
Refrigerating rooms cooled by mechanical means are
superior to those cooled by ice, as the supplies may be
kept much longer and in better state of preservation.
Ther.- should be sufficient storage space in which to
store all perishable food as soon as received. Storerooms
should be of sufficient size to insure proper separation and
classification of supplies, and proper stock slips and rec-
492
THE MODERN HOSPITAL
ords should be kept of the stock on hand, so there will
not be unnecessary duplications in purchasing.
In places where cereals are liable to become infested by
worms or bugs, if purchased in quantities, it is advisable
to have the storage place scrubbed frequently, disinfected
and whitewashed, and, in the summer months, if possible,
to store such cereals as are on hand in refrigerated rooms.
Food supplies should not be issued indiscriminately to
kitchens and dining rooms; they should only be issued
upon requisitions. All Issues should be made by weight,
count or measure. It is not generally understood what
large savings can be made through careful issuing of
food supplies on requisitions.
The deliveries should be made from the storehouse to
the kitchens in such a way that the supplies will not be-
come contaminated or deteriorate while in transit. Each
place of delivery, for its own protection as well as for
that of the storehouse, should be provided with scales for
weighing the supplies when received. Suitable storage
should be provided in the kitchens for a day's supply of
food and for keeping small quantities of canned and other
goods which the cook needs for emergency use. Ice stoi'-
age can be used in the kitchens, but it is much more satis-
factory to use small mechanical refrigerating plants.
Molasses, syrup, vinegar, cereals — in fact, no food sup-
ply— should be issued in original barrels or packages un-
less the quantity used by a kitchen for one meal will re-
quire an original package. There is a great loss in issuing
food supplies in bulk, since, when they are so issued, there
is no check on the cook. Food may be conserved by issu-
ing all food supplies in small quantities as needed.
Basic quantity tables of food supplies for issuing to
given numbers of persons should be used. It has been
found that, in hospitals where per capita tables for the
issuing of food supplies are not used, frequently the
same quantities of food will be issued for 100 persons as
would be issued if there were 125 persons. I remember
one instance in which as much food supplies were issued
for 1,200 persons as had formerly been issued for 1,400.
It can readily be seen that there should be a uniform sys-
tem to govern the quantity of supplies issued per capita
through the establishment of tables. Basic quantity ra-
tion tables for food supplies have been in use for over
eight years with very satisfactory results. Hospitals
can readily prepare their own basic quantity ration tables,
as it is a simple operation.
To prepare these tables, the quantity of food supplies
issued from the storeroom to the kitchens and dining
rooms should be tabulated and each quantity divided by
the total number of persons for whom the supplies were
issued and the total number of meals for which the sup-
plies were served. The final quotient will represent the
per capita issue of food for each meal. For institutions
where there are several kitchens, this plan should be fol-
lov/ed out in computing the food supplies issued to each
of the kitchens. When this has been done for each
kitchen, the per capita quantities issued should be set
up in vertical columns, so that comparisons may be made
and the general average issue may be found by adding
the given quantities of each of the food supplies issued to
the several kitchens, and then dividing by the number of
kitchens.
Where there are noticeable differences between the
quantity issued to a particular kitchen and the average
per capita issue to all kitchens, these differences should
be investigated to ascertain the cause. The next step
after making the computation is to prepare a basic quan-
tity ration table for use in the institution. Institutions
caring for different classes of patients will need different
tables, and it may be necessary to prepare several of these
tables before the right quantity is arrived at. They may
be prepared as described above by setting up the quanti-
ties in the same manner for the different classes of pa-
tients, officers, and employees. In arriving at the proper
per capita quantities in preparing a table, due regard
should be given to the quantity of waste left over after
a meal. The waste accounting system, which I will men-
tion later, will be found of great assistance in ascertaining
whether the quantities arrived at in the table are suffi-
cient or insufficient. Careful comparisons should be made
of the waste and usable food returned from the dining
rooms to the kitchens, for in this way it can be determined
how nearly the tables meet the situation.
The basic quantity ration tables are for the purpose of
insuring a proper and uniform quantity of uncooked food
to the kitchens for the number of persons to be fed. The
dietaries of a hospital should be made out a week, or at
least a day, in advance and a copy supplied to the per-
sons in charge of the dietary arrangements of the institu-
tion. From these dietaries the cooks in charge of the
kitchens should prepare their requisitions on the store-
house, which should be checked by the dietitian, and the
party in charge of the storehouse should see that the
supplies are in stock, using the quantities as shown in the
basic quantity ration tables previously established.
It is advisable for institutions to compute the food value
of the food issued at least monthly to ascertain whether
they are overfeeding or underfeeding. Too little care has
been given to this important part of the dietary arrange-
ments of an institution. No institution can tell whether
or not it is wasting food or underfeeding its patients
unless it makes computations of the food value of the sup-
plies used.
The prepai-ation and cooking of foods are so intimately
related that it would be difficult to separate the two opera-
tions.
In the preparation of food it is advisable to utilize
power-driven machinery where there is sufficient work to
warrant it, that is, dough-mixers, dividers, moulders, meat-
choppei's, dish-washers, knife-cleaners, kitchen machines,
etc. If vegetables are peeled, a vegetable-peeling machine
should be used. Bread-cutting machines should be used
for cutting the bread, a meat-slicing machine for slicing
the meat, and butter-cutting machine for cutting the
butter into individual portions. This will result in a sav-
ing of food.
Proper bakery equipment will increase the production
of bread. Meat-choppers will allow the utilization of
pieces of meat which would not otherwise be usable. Veg-
etable peeling machines will reduce the waste in vegeta-
bles from 15 to 20 percent, and, where vegetables have
been very poorly peeled, even to the extent of 30 percent.
Bread-cutting machines will save from 1 to 2 ounces of
the bread Issue per person per day. Meat-slicing ma-
chines will save from 3 to 10 percent in the slicing of
meat over the best hand-carving. Butter-cutting or serv-
ing machines will frequently show a saving of one-third,
particularly in cases in which the butter has previously
been placed on the table and the persons in the dining
room allowed to take butter at will, with the result that
it has been left on the plates and not used.
The preparation of meat naturally begins in the butcher
shop. The meat should be i-equisitioned according to the
basic quantity ration tables. Beef, mutton, and pork for
roasting, and beef and mutton for boiling should all be
weighed in the butcher shop in the usual way. After the
meat is weighed, each separate lot for each kitchen should
be boned and, where necessary, rolled and tied to keep it
THE MODERN HOSPITAL
493
together. It is desirable to bone all meat with the ex-
ception of steak, chops, and stew, and the use of steak and
chops should be limited. By "boning" is meant the re-
moval of all bones from pieces of meat which are used
for roast meat or boiled meat, so that they may be carved
with a meat-slicing machine. The meat should be cut
into as lai-ge pieces as can be roasted in the oven or in a
steam roaster, for large pieces of meat can be carved to
better advantage in a meat-slicing machine than small
ones.
For roasting meat and for baking, oven thermometers
should be used. Regular oven thermometers are now
manufactured for this purpose, and the manufacturers of
these thermometers publish booklets giving the tempera-
ture at which certain meats should be roasted and also
the temperature for different kinds of baking.
It is advisable to roast meat as rare as it will be eaten,
since this process alone effects a large saving of meat.
As fast as small pieces of meat are roasted they should
be removed from the roaster or from the oven. Rare,
medium, and well-done pieces can be obtained in this way.
Excess fat which is not needed in cooking the meat
should be trimmed from the meat in the butcher shop
before it is issued to the kitchens. It is a good practice
to save fat under normal conditions, but, now that fat
is so urgently needed for the carrying on of the war,
great care should be exei'cised to see that this is done,
for, by this procedure, a large amount of fat can be se-
cured for cooking purposes which will make it possible for
institutions to reduce their purchase of fats.
The use of oven thermometers will effect a saving in
meat of from 3 percent to 10 percent, and even as high
as 20 percent in some cases, by causing the cook to main-
tain the proper temperatures in the ovens.
Where there is excess fat left on the meat it is decom-
posed by the heat in roasting or it may be lost when the
meat is boiled unless it is carefully skimmed from the ket-
tle. All drippings or other fat produced in cooking should
be carefully saved. In each kitchen there should be a
kettle set apart for the saving of fats so that, after they
have been used to such an extent that they have become
too darkened for further use in foods, they may be used
in soap making.
It is not only a waste, but also a detriment to the meat
to carry too high oven temperatures. The fat is not only
decomposed but the protein of the meat is so hardened
that it becomes almost indigestible. Aversions on the
part of persons to rare meat can be overcome by gradually
cooking the meat more rare each week and in this way
accustoming them to eating i-are meat. By the proper
cooking of meat and carving it with meat-slicers as high
a saving as 30 percent may be made over poor cooking
and hand carving. A meat-slicer will show a material
saving over the most skillful hand carving.
To prevent the cooks from overcooking the meat, it
may be weighed just before it is placed in the oven and
again after it is roasted. Roast beef and mutton should
not lose in cooking more than 20 percent in weight, and
roast pork 25 to 30 percent. Chops and steaks may be
weighed before broiling or frying, and after the cooking
process. Other meats may also be weighed to advantage
before and after cooking. It may not be practicable to
do this at each meal unless sufficient help is available,
but tests should be made from time to time, to guard
against undue loss in the cooking of the meat. The
weighing of meat before and after cooking will save a
surprising quantity.
To prevent the waste of vegetables it is well to have
one central peeling room, which should be supplied with
modern equipment for the washing, weighing, and peeling
of vegetables and the preparation of vegetables for can-
ning or dehydrating. Very material savings of vegetables
can be made through centralizing their preparation.
No bread should be delivered on oral orders to kitchens
or dining rooms; requisitions should be prepared on a
basic quantity ration table for the bread to which the
dining room is entitled, and there should be no deviation
from the table of quantities without special reason. This
will prevent the baking of an oversupply of bread, which
may become stale. The dining room will take better care
of the bread and will give more careful supervision to the
serving of it if this rule is adopted. The elimination of
the waste of bread in kitchens and dining rooms will re-
sult in a large saving in flour.
In serving bread it is recommended that one slice be
served at a time. When the inmates of an institution
enter the dining room it might be well to have a slice of
bread beside each plate, for neai-ly every one will eat a
slice of bread. A certain number of inmates will eat two
slices, a few will eat three, and a smaller number will eat
four slices; but if, as is the practice in some dining rooms,
three slices are placed beside the inmate's plate at the
beginning of the meal, there can be but one result — a
large wastage of bread. When large loaves of bread are
baked, the slices should be cut in two, so that too large
slices will not be served at a time.
The remarks I have just made about bread refer par-
ticularly to institutions where there is more or less cus-
todial care. In general hospitals having tray service, the
bread used can be more easily controlled, as there can be
a standard quantity established for serving on each tray.
In tray and dining room service, care should be taken to
see that uniform quantities are served, for this will pre-
vent waste of food. Where a person requires more, he
can be given a second serving.
It is now quite a general practice, as a means of pre-
venting waste and securing satisfactory dining room serv-
ice, to adopt standard-size dishes for use in serving the
food. Dishes which will hold a certain number of services
should be used, together with individual dishes that will
hold a portion. If too small dishes are used, the services
will be insufficient, and, if too large dishes ai-e used for
a portion, too large quantities will be served, resulting in
a wastage of food, especially where graduated ration
dippers are not used. Institutions sometimes use bowls
and cups from two to three times larger than necessary.
In serving in bulk from the kitchen, dippers which are
graduated to show a definite number of portions of food
can be successfully used, and, where dishes have not been
standardized so that a uniform portion of food will be
given, ladles or other means of service can be used to
divide the food into individual services.
WASTE ACCOUNTING SYSTEM
Dining room waste is considered a hard thing to get at —
presumably, because it is not usually classified.
Persons who have inspected garbage cans know that
meat, potatoes, puddings, bread and other foods that ap-
pear to have been good when they were thrown in the cans
are found mixed with the garbage, and one frequently
hears the statement that institution kitchens and dining
room employees are so wasteful that a number of fami-
lies could be fed from the good food thrown into the gar-
bage. Inspection of garbage cans will not prevent lazy
or indifferent employees from throwing good food left
over from meals into the cans, for they know that no
adequate mental image can be formed of the good food
in a can of garbage, even though the garbage is dumped
494
THE MODERN HOSPITAL
from the can on to a platform or the ground and exam-
ined. It is impossible to visualize accurately quantities
and kinds of good food after it has been thrown into the
garbage, and this fact is known to administrative oiRcers.
Even with the assumption that the employees are effi-
cient and that each is conscientiously doing his work, the
inspection of garbage cans is still a failure, for the em-
ployees have no definite means of determining how much
garbage there should be. From week to week, without
attracting attention, the garbage may gradually increase
in bulk. The most alert employee will not notice this
increase, for the quantities will fluctuate from day to day
so that the gradual increase is not noticed.
The failure of garbage-can inspection to give satisfac-
tory results is due to the fact that its success depends
solely on the opinion formed by the person making the
inspection, who only "guesses" that the garbage is not
excessive; and, as time passes, this inadequate inspection
becomes lax, for there is no way of checking results
through making comparisons of different kitchens.
A waste accounting system will overcome these diffi-
culties. The good food that has not been served is classi-
fied as "usable food," which can be utilized by kitchens.
The waste and the good food are returned to the kitchen
in separate containers to be weighed and recorded on the
forms provided for that purpose.
This method of handling waste and usable food is a sat-
isfactory way of preventing good food from being thrown
in the garbage, for, through its operation, everything is
separated and weighed, so far as it can be, before being
thrown into the garbage, and this gives a complete record
of the garbage, from which comparisons can be made of
the waste (garbage) of the different kitchens.
The weighing of the waste not usable is one of the
means of determining whether the patients are receiving
sufficient food, and the weighing of the "usable food,"
which can be utilized by the kitchens (good food), is an
additional means of determining whether the patients are
receiving sufficient food. The weighing of both the good
food and waste not usable (garbage) shows whether or
not sufficient food has been issued, and, in the event of an
official inquiry with regard to the feeding, the waste rec-
ords would show whether or not enough food had been
served.
Some of the advantages readily recognized by admin-
istrative officers of institutions to be obtained by the
use of a waste accounting system over garbage-can in-
spection, are easily discernible.
With a waste accounting system all the waste (gar-
bage) is separated and classified under various heads.
The separation and weighing of the waste gives an admin-
istrative officer very necessary infoi-mation as to the
quantity left after a meal and shows conclusively, when
comparisons are made between a number of dining rooms,
whether or not a dining room is having a normal waste
of food. It is a decided advantage to an administrative
officer to have accurate information as to what makes up
the waste left over from a meal. Too much waste of any
particular article of food will indicate to him and the
dietitian that too much food has been served, that the food
was badly prepared or that, for some reason, it was unac-
ceptable, and this will at once start an inquiry to deter-
mine the cause.
On first thought, it might seem that this information
would be difficult to obtain and that a large amount of
additional work would be required in kitchens and dining
rooms. This, however, has not proved true, for the ex-
perience in the use of a waste accounting system in the
New York State hospitals and other institutions has
shown that this information may be obtained without in-
creasing the number of employees. In using the waste
accounting system all the waste is separated and classified
under the various heads. The food.left on the plates which
cannot be separated into the different kinds is recorded
as "plate scraps"; the bread left on the tables which has
been served is recorded as "bread"; potatoes, as "pota-
toes" (where boiled potatoes are served, the skins are
classed as "potato skins"); meat, as "meat"; vegeta-
bles, as "vegetables"; fish-bones, etc., according to name.
It is necessary to classify all food served and left on
plates as "waste"; food remaining in the serving room
or on the table, unserved, should not be classified with the
"waste" but should be returned to the kitchens as "usable
food."
The waste accounting system has been used with very
marked results in one of the New York state hospitals
since 1911, and in all of the New York state hospitals
since 1917; in some institutions in the state of Penn-
sylvania for over five years; and in all institutions of
the Pi'ovince of Ontario, Canada, since November, 1914.
Such marked results have been obtained through its use
that institutions have reported they had either to de-
crease the number of hogs formerly kept, as there was not
sufficient garbage to feed them, or to purchase feed for
the hogs. The feeding of garbage to swine is a ready way
of utilizing garbage, but garbage is actually an expensive
hog feed. From the standpoint of economy and food con-
servation, all unnecessary garbage should be eliminated.
No garbage, therefore, should be allowed to result from
a meal with the idea that it is not a dead loss on account
of being fed to the hogs, since hog feed can be purchased
at a much less cost than the food supplies contained in
garbage.
It is reasonable to expect the following results from the
use of a waste accounting system:
1. It checks both underissues and overissues of food
to dining rooms.
2. It causes dining rooms to serve food more carefully.
3. It prevents dining rooms from throwing a large
quantity of good food into the garbage cans.
4. It teaches the kitchen and dining roorn employees to
handle food supplies in a cai-eful and economical manner.
5. It gives kitchen and dining room employees an in-
centive to do good work, as the waste reports show which
kitchens and dining rooms are run efficiently and which
are run poorly.
6. It is beneficial to the inmates of an institution be-
cause it results in a minimum of waste of food in the
kitchen and dining room operations and more care in
cooking and serving, and because, as the waste is lessened,
more food is available for service.
7. If the saving resulting from the use of the waste
accounting system is not needed to improve the dietary
of the patients, there will be a reduced expenditure for
food supplies.
HOW TO USE A WASTE ACCOUNTING SYSTEM
In places where a waste accounting system has not
been used, it would be best to institute its use by first
weighing all waste not usable and making one entry of
it under "plate scraps" on report blanks. Every few days,
as the kitchen and dining room employees grow more ac-
customed to the new order of things, subdivisions of the
waste can be made, until the system is in full operation.
Great care should be given to the "usable food" which ,
can be utilized by the kitchens, which should also be en-
tered on the report blanks.
When using the waste accounting system the dining
rooms, instead of dumping all the waste from the tables
into one container after the meal, gather up separately,
as far as possible, the different food articles which have
been served and are left on the plates and on the tables.
THE MODERN HOSPITAL
49o
Where there is more than one ward served in the same
dining room, the different wards gather the waste from
their tables and bring it to the serving room of the dining
room, and the same kind of waste from the tables of the
different wards is put in one container, after which the
several containers are sent to the kitchen to be weighed.
The food on the tables which has not been served is
classified as "usable food" and returned from the sei-ving
room to the kitchen in separate containers, to be weighed
and utilized again in subsequent meals. An employee in
each kitchen is detailed to weigh the waste and usable
food when the dining rooms bring it back to the kitchen
When a kitchen is cooking for but two or three dining
rooms, the additional work is of little account, but, whei'e
they receive waste from several dining rooms, the installa-
tion of the system causes some additional work at the
start. After the system is in operation, little trouble
is experienced, and the cooks prefer this method to the
old way for the reason that, with the old system, they
could not know when too much of any food was supplied
to a dining room. Under garbage-can inspection the dif-
ferent kinds of food left from a meal are returned to
the kitchen in one receptacle, into which all kinds of food
has been thrown, and, if a dining room receives too much
or too little of any kind of food, it is hard for the cook
to determine this fact. With the waste accounting sys-
tem, an overissue of any food sent to the dining room
is plainly indicated when the waste and usable food ic
later returned from the dining room to the kitchen and
weighed.
In separating the food and sending the proper quanti-
ties to the different dining rooms, the cook has to use
considerable judgment and, unless he has some way of
checking the subdivision he has made of the cooked food
in bulk, he is very liable to make mistakes and send too
large or too small quantities to some place. The assist-
ance the waste accounting system gives the chef and the
cooks in the accurate distribution of cooked food to the
different dining rooms moi'e than offsets the work the
system causes.
RECORD OF WASTE
Accurate records should be kept of the waste and usable
food returned to the kitchens from the dining rooms.
For this purpose a waste report blank should be used
in the kitchens, on which is recorded what is returned by
the dining rooms. A supply of these blanks should be
placed in a suitable binder and kept in the kitchens,
proper entries being made after each meal on the blank
'for that day.
Some institutions make daily summaries of these blanks,
other institutions weekly summaries, and still others pre-
fer to make a monthly summary. The weighing and re-
cording of the waste and usable food is usually done by
the kitchens, but in some institutions the dining rooms
are required to do this. It is recommended that the
weighing and recording of the waste be done in the
kitchen, so that this work may be centralized and the
kitchens used in keeping a check on the dining rooms. It
is also recommended that the other records, monthly sum-
mary, and comparison sheets, be prepared in one of the
administrative offices from the information supplied by the
daily reports of waste and usable food returned by dining
rooms to kitchens.
A properly supervised dietary and the operation of a
waste accounting system will result in distinct economy
through the prevention of food waste in hospitals. If a
hospital has a census of 2,000 persons, it means that 6,000
meals are pi'epared each day. If but one ounce more than
necessary of waste per person a day is thrown into the
garbage, it will aggregate 125 pounds of food thro^vn
away per day; in one year the waste will be 45,625
pounds; if this waste is worth 10 cents a pound, as it
may easily be worth, it will mean that, for every 2,000 per-
sons, the institution is needlessly throwing away $4,562.50
worth of food. The average institution is likely to save
considerably over one ounce per capita per day by a well-
operated waste system. After the waste system is in
thorough working order, the table waste per capita for
employees should not exceed 2'/2 ounces daily, and for in-
mates, not more than Hi ounces. The returned usable
food is usually from one-half to three-fourths as much as
the waste. The quantities given are maximum quantities,
and hospitals should have less waste than this.
The United States Food Administration is very much
in earnest in its efforts to prevent food waste. The
Statistical Division Information Service is receiving
monthly reports of garbage collections and garbage grease
from a number of cities. A compilation of the informa-
tion received for the month of July, 1918, shows that the
collection during July of garbage was 9 percent less than
for the corresponding month last year. There is a slight
increase in the collections for the month of July over that
in June, 1918. The compilations for garbage during July,
1918, were received from 74 cities. The records of seven
of these cannot be included because of insufficient data,
leaving 67 cities, with a total population of over 20,000,-
000, to supply the data assembled. For these cities, the
amount of garbage per capita for the month is about one-
half pound daily. The summary of garbage grease re-
covered in July, 1918, shows a decrease of 16 percent from
July, 1917. The returns are from cities having a total
population of over 6,500,000. The percentage of garbage
grease collected is less in July, 1918, than a year ago.
In order to impress upon his troops the lesson of indi-
vidual food conservation, the commandant at Fort Meyer
paraded his soldiers in a foi'mal manner before the
crowded garbage tins of the camp. "There is evidence,"
he told them, "that your eyes are bigger than your stom-
achs."
"Prominent among numerous economies lately intro-
duced at army camps and cantonments are those dealing
with kitchen" by-products. Every organization of the
army conducting a 'mess' makes the following classifica-
tion" of kitchen waste produced in preparing and serving
each meal.
CLASSES OF WASTE PRODUCTS
A. Bread — which will include all breadstuff unfit for human food. It
will be dried and sacked for delivery.
B. Cooked meat — which will include all meat gathered up from the
individual plates after meals.
C. Raw fats and meats — which will include the trimmings and raw
scraps rejected for use as food and meat condemned by health authori-
ties as unfit for human consumption.
D. Cooked grease — which will include all grease discarded as being of
no further value as human food.
E. Bones — which will include all bones discarded in the preparation
and use of human food.
F. Other garbage — which will include all unusable portions of food
not otherwise classified and will not include coffee grounds, glass, or
other substances injurious for use as food for animals. This shall be
mixed with ashes and disposed of in like manner.
"The first five classes of waste products are disposed
of through commercial channels chiefly for conversion
into grease, glue, fertilizer, poultry and animal feeds.
What should particularly interest farmers having land
near army camps and cantonments is the Class F material,
the 'other garbage.'
"The United States Food Administration calls particu-
lar attention to the desirability of such garbage as feed
for hogs. It is free from coffee grounds, glass and other
injurious substances, and large camps will produce 8 to
10 ton= of this feed a day, enough to feed 800 hogs. Last
year the city of Worcester, Mass., fed its garbage to hogs
and reported swine raised and sold to the amount of $44,-
487; the profits exceeded $36,000. If a city can get these
results, a trained farmer who feeds his hogs high-grade
496
THE MODERN HOSPITAL
camp garbage should be able to do as well or better.
Methods of practical garbage utilization by hog feeding
will be supplied by the Food Administration on I'equest."
The newspaper release of the United States Food Ad-
ministration, from which I have been quoting with refer-
ence to classes of waste products in army camps and
cantonments, was sent to farm journals only for release
after August 19th.
The Federal Food Board for the state of New York, in
its daily bulletin for September 9, 1918, says:
"Sixty nutrition officers have been appointed in the na-
tional army camps to carry on the woi'k of cui'tailing
waste of food in cantonments and camps. They will ad-
vise as to the nutritional values of dietaries and will co-
operate with the officials to prevent spoilage of food.
In one camp the average edible waste was found to be
1.12 pounds per man per day. Instructions for economiz-
ing were given, which resulted in reducing the waste to
approximately 0.43 pounds per man per day, according
to the findings in a second sui-vey. It is expected that this
plan will mean a considerable saving to the government
in money as well as an aid to food conservation."
Institutions should certainly not have as much waste
as army camps, since they have better facilities and better
equipment than the camps have and their personnel does
not change so frequently. It behooves all hospitals and
institutions to redouble their efforts to prevent food
waste, for, under normal conditions, over one-third of the
total expenditures of an institution is for food supplies.
It is not only a matter of economy to prevent food waste
but also a patriotic duty. We have all been electrified by
the five words "Food Will Win the War," and there is no
better way of providing this food than by saving what
we have through prevention of food waste. On account
of their special training dietitians are better equipped to
lead the movement to prevent food waste than other per-
sons, and they are, I believe, doing their part to assist
the United States Food Administration in its conserva-
tion program.
I would urge all persons to redouble their efforts to pre-
vent waste of food for, despite this year's bountiful har-
vest, food conservation must be intensified to meet the
demands of our army and the civilian populations of the
United States and allied countries.
NEWS NOTES OF DIETITIANS
Miss Evaline Kerr, formerly of Almeda County Hos-
pital, California, is now with Base Hospital No. 1 at Fort
Sam Houston, San Antonio, Texas.
Miss Bernice Butler, who has been at Camp Doniphan,
Fort Sill, Oklahoma, is now with Hospital Unit 70. The
latest news from Miss Butler was that she was in New
York City getting equipment and making other prepara-
tion for overseas duty.
Miss Aline Brownlie has been appointed dietitian in
Fabiola Hospital, Oakland, California.
Last month we reported the appointment of Miss Vio-
let Kyley to supervise the dietitian work in the Army
Nurse Corps and Red Cross. Miss Ryley resigned her
position and returned to Canada about the time our copy
went to press. She did not assume the duties of the work
here, but is doing her work in Canada with the Invalid
Soldier's Commission.
Miss Lenna Cooper of the Battle Creek Sanitarium,
Battle Creek, Michigan, has been appointed to succeed
Miss Ryley. Miss Cooper has had a wide experience in
institutional work and is familiar with the situation in
the dietary departments of both civil and military hos-
pitals. Her keen perception and good judgment will help
to overcome many of the difficulties and problems which
have prevailed in the field of dietetics.
Miss Maude Anne Thomas, chief dietitian of the Phila-
delphia Hospital, Philadelphia, died of influenza, Oct. 21,
1918, at the hospital, after a two weeks' illness. Miss
Thomas was dietitian at The Massilon Hospital, Massilon,
Ohio, and at The Southside Hospital, Pittsburgh, for some
years before coming to Philadelphia. She took up the
duties of chief dietitian at the Philadelphia Hospital early
in 1917. Her work at that place was of splendid charac-
ter. In spite of war conditions she succeeded in insti-
tuting improvements and in solving many difficult prob-
lems. Her cheerful disposition and loyal cooperation were
always inspiring, and she will be greatly missed by her
associates and friends. Miss Thomas was a member of
the dietitians' section of the Home Economics Associa-
tion of Philadelphia.
The Care of Tuberculous Soldiers
Statistics gathered by the medical department of the
Italian Army show that the number of soldiers discharged
on account of tuberculosis is inversely proportionate to
the time passed under arms; in other words, that the
number of tuberculous soldiers who have served only one
or two months is very large, while the disease is much
rarer among the men who have served a long period of
time. This is clearly due to the fact that a great number
of men with latent tuberculosis was taken into the army.
The medical department now insists on a close and rigid
examination of all recruits, and men with suspected tu-
berculosis are sent to special centers whei'e they ai'e ex-
amined by the most modern methods and kept under ob-
servation for a certain period of time, says S. Pisani,
writing in the Rivista Critica di Clinica Medicina of
Florence.
The soldiers discharged from the army because of tu-
berculosis are divided into three groups, cases of incipi-
ent, intermediate and advanced tuberculosis. Patients of
the first class are sent to climatic institutions in the
mountains or on the seashore, seven of which under man-
agement of the Red Cross are already in operation. When
cured these soldiers return to the army. The cases of
the second group are returned by special Red Cross train
to the provinces from which they came, where they are
cared for and treated in open-air institutions. Patients
of the third group, the hopeless cases, are cared for in
special tuberculosis hospitals. The author calls atten-
tion to the gi-eat difference of the treatment of tubercu-
lous soldiers now and before the war, when they were
simply sent home and left to themselves.
The New Radiological Division of the St. John's Hospital
in Turin
The new radiological clinic of St. John's Hospital is
housed in a separate pavilion and is divided into two sec-
tions, the radiological institute proper and the hospital
section. The first section has eight large rooms devoted
to diagnosis, radium treatment, x-ray application, etc
The hospital section has 17 beds, 10 for female and 7 for
male patients. The institution is splendidly equipped
with all kinds of apparatus. It has 8 radium tubes con-
taining, in all, 340 mg. of radium.
The clinic is described by C. Boidi-Trotti, in Radiol Med.
of Milan.
Many people are born crying and die disappointed.
They chew the bitter pill which they would not even know
was bitter if they had the sense to swallow it whole in a
cup of patience and water. — C. H. Spurgeon.
THE MODERN HOSPITAL
497
Splendid Industrial Cooperation Results in Speedy Influ-
enza Relief
To the Editor of The Modern Hospital:
Thinking that you would be interested in knowing the
measures taken "back to the Yards" when the influenza
epidemic was at its height, I am sending you the follow-
ing brief description.
About Friday and Saturday, October 18 and 19, from
the reports of all nurses and doctors, it looked as though
we were in for the worst epidemic in the history of this
district. There were many deaths, new cases increasing
rapidly, and whole families stricken at the same time.
In some cases, parents were ill and there was no one to
provide food for the children. The scene as it was could
never be painted in its true colors.
Dr. O'Neil of the Municipal Tuberculosis Sanitarium
was appointed by the health department as officer in
charge of this district in influenza emergency measures.
As there was no longer any i-oom in local hospitals, he
conceived the idea of an emergency hospital at the Uni-
versity of Chicago Settlement, 4630 Gross avenue.
The idea soon became a reality. The packing compa-
nies, acting through the Stock Yards Community Clearing
House, immediately responded to the need, so that beds,
cots, blankets, etc., were quickly transferred from summer
camps to be used for emergency hospital purposes. Other
equipment that could not be immediately furnished by
the packing companies, settlement, or other organizations
was purchased outright. It was a desperate move to save
lives. Within a short time the arrangement was com-
pleted and a real hospital was in operation in the settle-
ment gymnasium with four nurses in charge and twenty
patients. As this effort was made when the epidemic was
at high tide, we did not have to provide for more than
twenty patients, for regular hospitals soon reported room
for community cases.
The unique feature of this endeavor was the quick ac-
tion which brought relief on short notice, the splendid co-
operation of industries, local doctors and nurses, and local
social organizations. Of the twenty patients received but
one died, and this was a small child who was almost be-
yond hope when brought to the emergency hospital. There
were several very serious cases of pneumonia, but with
splendid care the patients fully recovered and were soon
discharged. It was the feeling of those who shared the
responsibility of the hospital that without a doubt, lives
were saved by this heroic effort.
Diet kitchens were also established at the University
Settlement, House of Social Service, and Chase House,
and more than five thousand meals were carried by vol-
unteers to families who were not physically able to pro-
vide themselves with food. It was not necessarily a mat-
ter of charity but rather a matter of providing proper
food in the quickest way possible for those who were not
able to prepare it for themselves.
The packing companies paid the entire expense of these
diet kitchens, as well as the expense of the hospital. They
purchased the food and delivered it to the kitchens, in
order to save the time and energy of those who were
preparing and distributing it.
I have taken the pains to go into some detail on this
subject, as I am sure The Modern Hospital is especially
interested. Perhaps this is one of the most unique experi-
ments in the city in dealing with a very bad situation,
which luckily soon passed.
The output of our diet kitchen is now reduced to forty
or fifty meals a day, and the hospital is no longer needed.
The number of deaths and new cases, as now reported, is
very low.
Emerson O. Bradshaw,
Director, Stock Yards Community Clearing House, Chicapo.
The Hospital of Ilbarritz, a Center for Patients with Ex-
ternal Tuberculosis
Much has been written about pulmonary tuberculosis in
the armies of the present war, but few writers mention
the cases of external tuberculosis. Yet this class of pa-
tients, especially cases of tubercular lesions of the bones
and joints, is very large. As far back as 1916 the French
medical service established special center's for this form
of tuberculosis along the west coast of France, at La
Rochelle, Arcachon, Cap-Breton and Biarritz. The hos-
pital of Ilbarritz, near Biarritz on the Bay of Biscay, was
established in the beautiful chateau of the same name,
situated on a high promontory overlooking the bay. The
rooms are large, airy, and provided with ample verandas.
This hospital is peculiarly well adapted to the treat-
ment of external tuberculosis. The usual therapeutic
methods are combined with heliotherapy. Immobiliza-
tion is one of the chief elements of the treatment. The
patients are kept in their rooms only during the night.
Early in the morning they are rolled out on the large
verandas and terraces where they are exposed to the
curative effects of the sunlight and breathe the invigor-
ating salt air of the bay. The hospital is under the man-
agement of Madame Williams assisted by two American
ladies, Mesdames Frothingham and White. It is de-
scribed by Peyret and Fournier in the Journal de Medecine .
de Bordeaux.
Tuberculosis Sanatoriums in High Altitudes and on the
Plains
E. R. Coni maintains that there is no special climate
for the cure of tuberculosis. For successful treatment
the disease requires merely fresh air, rest and good and
abundant food. It is not necessary to send the patient to
the mountains, where he is away from his family and
becomes a victim of nostalgia and where he lacks the econ-
veniences and aids which his delicate condition requires.
Sanatoriums should be established in the country, not far
from the great centers of population. The great moun-
tain sanatorium, Santa Maria, with 700 beds, has not
been a success, while the Tornu Sanatorium, established
in 1904 and situated in the plain, about ten miles from
Buenos Aires, has been remarkably successful in its
cures. To combat tuberculosis the author proposes that
the government should establish numerous tuberculosis
dispensaries and two large sanatoriums near the capital,
one for men and one for women, besides an agricultural
colony -.vhere the patient could complete his cure before
returning to his former work.
Coni's article appears in the Semana Medica of Buenos
Aires.
498
THE MODERN HOSPITAL
Dispensaries, Their Management and Development. By
Michael M. Davis, Jr., Director of the Boston Dis-
pensary, and Andrew R. Warner, M.D., Superintendent
of Lalceside Hospital, Cleveland, Ohio. Cloth, pp. 426,
$2.25. The Macraillan Company, New York. 1918.
That a book like this has not appeared sooner is rather
amazing when one considers what an increasingly import-
ant part dispensaries have been playing in the care of
the ambulatory sick during the past fifteen years, a period
during which their number has increased from about one
hundred and seventy dispensaries to approximately three
thousand of all classes. Stimulated by the unremitting
efforts of agencies organized to combat disease and by
the growing interest in health as a national asset, we may
expect dispensaries to continue to grow in number, and
so evolve in character as to fill a much larger field of
usefulness not only in the treatment of sickness but in
the prevention of disease.
In the words of the joint authors, the book has a three-
fold object: (1) to depict briefly the history and present
extent of dispensaries in the United States; (2) to present
the practical details which all people, including superin-
tendents, physicians, nurses and social workers, who are
working in dispensaries, particularly need to know; (3) to
present the dispensary as a form of organization not only
for rendering efficient medical service to the people, but
also for benefiting the medical profession by stabilizing
the economic position of the average physician.
The history of dispensaries in the United States is in-
deed depicted briefly, and if the reader comes to the book
looking for more than the barest outline of the growth
of dispensaries in the United States, he is doomed to dis-
appointment. But this is a virtue rather than a fault,
since the inclusion of a more elaborate historical exposi-
tion would have made the book uninvitingly long. The
sections of most practical use are those devoted to funda-
mental principles and technic. Here the reader who is
mterested either in organizing a new dispensary or in
organizing additional clinics in already existing insti-
tutions, or in improving the organization, equipment or
technic of existing dispensaries, will find a wealth of
practical suggestions and information, whose peculiar
value lies in the fact that it emanates from the eight
years of experience of one of the authors in reorganizing
and building up one of the largest dispensaries in the
country.
The last five chapters of the book bulks large in pro-
phecy of a worth-while character, and are especially stim-
ulating. With the passing of the "family physician," and
the increase in specialization, we are on the verge of a
new era — the era of cooperative medical practice in which
the dispensary is bound to play one of the leading roles.
How this development will tend to stabilize the economic
status of the average physician is interestingly set forth.
The authors are not unmindful of the deficiencies of pres-
ent dispensary organization, and realize that these defi-
ciencies must be corrected is dispensaries are to occupy
acceptably the larger sphere they seem destined to fill.
The rapidity with which dispensaries will develop into
agencies of larger service to the people will depend very
much upon the rapidity with which the general public
comes to know what the cooperative practice of medicine
means, and what it involves.
Appended to the volume is a comprehensive biblio-
graphy, suggestions for by-law and administrative rules
of a dispensary, and a copy of the recently enacted Mass-
achusetts dispensary law.
BOOKS RECEIVED FOR REVIEW
Walter James Dodd. By John Macy, Writer and Critic.
A biographical sketch with illustrations. Cloth, pp. 64.
$1.50. Board. Houghton, Mifflin Co., Boston, 1918.
Hygiene of the Eye. By Wm. Campbell Posey, A.B., M.D.,
Professor of Diseases of the Eye in the Philadelphia
Polyclinic; Ophthalmologist to the Department of Phys-
ical" Education of the University of Pennsylvania; and
Chairman of the Commission on Conservation of Vision
of Pennsylvania. Cloth, pp. 331, 120 illustrations, $4.00.
J. B. Lippincott Company, Philadelphia, 1918.
English, French, Italian Medical Vocabulary. By Joseph
Marie. Including reference tables of special value to
physicians and nurses, phrases for directing first aid
to the injured, articles on pronunciation, European
monev tables, etc. Cloth, pp. 112, $0.50. P. Blakiston's
Son & Co., Philadelphia, 1918.
In the Soldier's Service — The War Experiences of an
American Woman in England, Belgium and France,
1914-1918, with illustrations. Bv Mary Dexter. Paper,
pp. 209, $1.50. Houghton Mifflin Company, Boston, 1918.
Anatomy and Physiology for Nurses. By Diana Clifford
Kimber, formerly Assistant Superintendent New York
City Training School for Nurses, formerly Assistant
Superintendent Illinois Training School, and Carolyn E.
Grav, Principal Citv Hospital School of Nursing, New
York. Cloth, pp. 49'0, 225 illustrations, $2.60. The Mac-
millan Company, New York, 1918.
Animal Parasites and Human Disease. By Asa C. Chand-
ler, M.S., Ph.D., Instructor in Zoology, Oregon Agricul-
tural College, Corvallis, Oi'egon. Cloth, pp. 570, illus-
trated, $4.50. John Wiley & Sons, Inc., New York, 1918.
Principles of Surgical Nursing. A Guide to Modern Surgi-
cal Technic. By Frederick C. Warnshuis, M.D., F.A.
C.S., Visiting Surgeon, Buttei-worth Hospital. Grand
Rapids, Mich., Chief Surgeon, Pere Marquette Railway.
Cloth, pp. 277, with 255 illustrations, $2.50. W. B. Saun-
ders Company, Philadelphia, 1918.
How France, During the War, Has Organized the Anti-
tuberculosis Work with Regard to Infected Soldiers
All soldiers infected, or suspected of being infected
with tuberculosis, are divided into three groups, curable
cases, permanently incui'able cases and an intermediate
class. The curable patients are treated in special hos-
pitals, stations sanitaires, and, after being cured, take
their former place in the army or are employed in an
auxiliary service. The incurable cases are either isolated
in special hospitals or sent to their homes if there is no
danger of spreading the infection. The patients of the
third group who can still perform useful work, are sent
to their homes after having received prophylactic instruc-
tions regarding their disease. The stations sanitaires,
of which there are at present twenty-eight, with 5,500
beds, have the character of sanitariums. The educational
woi'k is in the hands of competent ladies, usually widows
of officers. The patients sent to their homes are under
the constant supervision of visiting nurses.
E. Bertarelli describes this work in the Rivista di igiene
e di sail. pub. of Parma.
THE MODERN HOSPITAL
499
CURRENT
HOSPITAL
LITERATURE
ALBERT ALLEMANN, M. D.. Foreign Literature.
Army Medical Museum and Library, Office of the Surgeon-General,
United States Army.
The Radio-Chirurgical Aeroplane. M. A. Nemirovsky and
M. Tilmant. Bull. Acad, de Med., 1918, LXXX, No. 35.
M. Nemirovsky, head of the radiological laboratories of
the Spanish and Russian hospitals, and M. Tilmant, a
member of the French Army Medical Corps attached to
the United States Army, describe an aeroplane intended
to carry aid to the wounded. The machine carries a pilot,
a surgeon, and an radiologist (who should also be quali-
fied as a surgical assistant), surgical material, dressings,
and an x-ray installation. It is evident that the object
of this formation is not to carry the wounded and to
operate on them in an aeroplane, but rather to carry
fairly complete surgical and radiological equipment and
the necessary personnel either to an individual wounded
man or to points where there is urgent need of reinforce-
ment of the surgical staff.
The apparatus has the advantage of extreme speed and
of not encumbering the radios or of being blocked by the
only by the city of Rosario, where an association for com-
bating tuberculosis was put on foot. In the other prov-
inces, nothing or very little has been done. The prin-
cipal means of combating tuberculosis is the dispensary,
which forms a center of action, investigation, and prophy-
laxis. Such dispensaries should be established in all the
capitals and chief cities of the provinces, and should be
controlled by the provincial and municipal medical officers.
At the same time tuberculosis hospitals should be estab-
lished, and the general hospitals should be entirely freed
from tuberculous patients. Later, the provinces should
also be able to establish sanatoriums for the cure of
tuberculosis, either in the mountains or on the seacoast.
The author mentions sanatorium statistics of the Pruden-
tial Insurance Company of America. From 1909 to 1913,
6,767 patients received sanatorium treatment, and of these
43 percent were cured, while 30 percent were greatly im-
proved.
The Nemirovsky-Tilmant radio-chirurgical aeroplane; (1) surgical-as-
sistant-radiologist : (2) electric generator; (3) pilot; (4) sur-
geon; (5) surgical instruments: (6) sterilized dressings; (7)
x-ray apparatus.
congestion of traffic. The instrumental equipment has
been especially designed with a view to lightness and
compactness, and, as shown in the illustrations, it is
highly compendious.
The electro-generator of the aeroplane itself furnishes
the current for lighting and for the x-rays. It needs to
be supplemented by a small transformer and interrupter.
The same current can be used for heating the electric
sterilizers.
Antituberculosis Organization in the Provinces. E. R.
Coni. Semana Med., Buenos Aires, 1918, XXV, No. 17.
The example of Buenos Aires, where an energetic anti-
tuberculosis campaign has been organized, was imitated
The Neurological Center of the Territorial Army at Genoa,
Quaderni di psichiat., Genoa, 1918, V, No. 7.
This military neurological center consists of two dis-
tinct hospitals, the Missionari and the Spinola Hospital.
The former is devoted to simple functional psychoneurotic
troubles. It has an isolation ward for excited cases and
for patients needing close observation, and a ward for
quiet psychoneurotics, a division for patients with or-
ganic lesions not due to military service (myelitis, lues),
and an officers' division. The rooms are small, holding
only two or three beds in order to facilitate eventual isola-
tion and to obviate contagion in the hysterical forms as
much as possible. The functional hysterical cases (aph-
onia, stuttering, abasia, paralysis, etc.) are subjected
to a new and special treatment. After a short period
of isolation, during which suggestion is used, the patient
is brought into a state of excitement, and a strong electric
current is applied, while at the same time suggestion and
oral persuasion act on the mind of the subject. This
method has been successful in the most inveterate cases.
The Spinola Hospital receives only patients with trau-
matic lesions of the nervous system. The therapeutic
principles of the hospital are as follows : All psychogenic
(hysterical) complications resulting from the organic
lesion must at once be removed, such as tremors, contrac-
tures, false positions of the members, etc. Each patient
must be studied closely and intensely. No patient is al-
lowed to remain inactive.
The Psychopathic Hospital of the Laboratory of Social
Hygiene, Bedford Hills, N. Y. Katharine Davis, E. E.
Southard et al. Jour. Sociol. Med., Pittsburgh, Pa.,
1918, XIX, No. 2.
This hospital was established through the efforts of
Mr. Rockefellei', Jr. A tract of land adjoining the New
York State Reformatory was purchased, and a building
capable of accommodating fifty inmates and a staff of
eleven persons was erected. The hospital receives every
woman committed to the State Reformatory. Its pur-
pose is the intensive study of criminal women who show
an abnormal mentality, but who cannot be considered
insane. The laboratory maintains three departments.
The department of sociology makes a thorough investiga-
tion of the social history of each patient, including her
heredity, environment, etc. The department of psychology
chiefly applies mental tests. The department of psychiatry
carries out the scientific study of psychopathic cases and
experiments with the various methods of treatment.
500
THE MODERN HOSPITAL
NEW
INSTRUMENTS
AND EQUIPMENT
VINCENZ MUELLER. Technical Editor.
GEO. W- WALLERICH. Associate Editor.
Please address items of news and inquiries regarding New Instru-
ments and Appliances to the editor of this department. 327 Southeast
Avenue. Oak Park, Illinois.
Light-Proof Dark-Room Ventilators
The lack of ventilation in the ordinary laboratory dark-
room has long been a serious question. In the majority
of instances the developing room or, as ordinarily called,
dark-room, is simply a makeshift, an ordinary room with
close-fitting door, windows securely fastened and painted
black, and without ventilation, except such as is obtained
by the infrequent opening of the door. As a result roent-
genographers and their technicians have been forced to
work under most insanitary as well as unsavory condi-
tions, greatly impairing their efficiency. This condition
has been due not so much to inattention as to the dif-
ficulty in obtaining proper ventilation and at the same
time preventing the admission of light.
A comparatively recent invention, however, seems to
have solved the question satisfactorily. The Freyberg
Light-Proof Dark-Room Ventilators are designed to pro-
vide ventilation in Roentgen operating rooms, developing
rooms, or other places where ventilation is desired with
the positive exclusion of light. These ventilators were
designed after long experiments and have proved very
satisfactory for the purpose for which they are intended.
They are made of sheet metal in the form of a rectangular
box enclosing the series of vertically arranged planes set
parallel to each other with air passages between. These
planes ai'e irregulai'ly zigzagged at angles properly de-
termined to nullify reflection, thereby completely exclud-
ing both direct and reflected light within the air pas-
Plain liKht-proof dark-room ventilator
sages and yet providing ventilation. Total absence of
light with a ventilating area of 6.5 percent of the hori-
zontal dimension by the full height of the ventilator is
the result.
The ventilators are made in two styles, one plain, for
use in interior partitions or where it is not necessary to
control the amount of ventilation, and the other style
which is the same as the plain, but fitted with a Pantasote
spring roller shade in a separate frame attached to the
ventilator for controlling the ventilation when installed in
an opening communicating with the open air.
A very satisfactory arrangement is for the installation
of the ventilator on the outside of the lower sash of a
window. This permits the use of the upper sash for
ordinary purposes and also makes possible the use of the
lower sash to control the amount of ventilation desired.
Light-proof dark
ng shade control partly closed
Another method is to install the ventilator in an existing
window opening parallel to the upper sash. This will per-
mit the ordinary use of the lower sash while the upper
sash when pulled down makes the ventilation effective.
Owing to the fact that these ventilators must be con-
structed to meet individual requirements they are made to
order only. They ai'e frequently installed in pairs, one in
an interior passage partition and the other opposite an
opening to the open air to promote air circulation.
The Hygienic Work of the Anti-tuberculosis Dispensaries
The function of tuberculosis dispensaries is not so
much to treat tuberculous patients as to prevent the dis-
ease, especially among the young people and the children.
Their chief work consists in education and propaganda,
which will furnish the people defensive arms against a
diseases which hospitals and sanatoriums try in vain to
combat. This does not mean that the dispensaries should
give up entirely the treatment of patients, for they are
a valuable aid to the sanatoriums; but it is their su-
preme duty in the highest interest of the nation to pre-
vent sound persons from falling prey to the disease. In
the present state of therapeutics the successful struggle
with tuberculosis depends chiefly on prophylaxis. Of
great importance are domiciliary visits of the physicians
and specially trained nurses who at regular intervals see
the families of patients, study their needs, comfort them
and teach them how to prevent the spread of the disease.
Every dispensary should at certain periods put up posters
in prominent places (schools, hospitals, churches, thea-
ters) calling attention to its existence and its purpose.
A small booklet containing information regarding the
disease and advice how to prevent it should be handed to
all visitors, says D. Ottolenghi, writing in Igietie Moderna
of Genoa.
BINDING LIST APR J 1954
9fcO
M7
v.ll
cop. 2
Biological
& Medical
Serials
The Modem hospital
PLEASE DO NOT REMOVE
CARDS OR SLIPS FROM THIS POCKET
UNIVERSITY OF TORONTO LIBRARY
Live Music
Archive
Librivox
Free Audio
Metropolitan Museum
Cleveland
Museum of Art
Internet
Arcade
Console Living Room
Open Library
American
Libraries
TV News
Understanding
9/11